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Causes and Risk Factors of Macular Degeneration
What Is Age-Related Macular Degeneration?
AMD is a chronic disease of the retina, the light-sensitive tissue lining the back of the eye. It primarily affects the macula and is the most common cause of irreversible central vision loss in people over 60 in the United States, according to the National Eye Institute.
The macula is a small but essential part of the retina. It powers the sharp, detailed central vision you rely on for reading, driving, and recognizing people. Without a healthy macula, these everyday activities become difficult. Peripheral, or side, vision does not depend on the macula and is typically preserved even in advanced AMD.
About 85 percent of people with AMD have the dry form, according to the National Eye Institute. Dry AMD develops as the macula thins with age and tiny yellowish deposits called drusen accumulate beneath the retina. Drusen are composed of proteins and fats that the retina cannot fully clear away on its own.
Small drusen are common as people age and do not always signal a problem. Larger or more numerous drusen can indicate the early stages of AMD and raise the risk of future vision loss. In its most advanced form, dry AMD can progress to geographic atrophy, a condition in which patches of retinal cells in the macula permanently die off.
Wet AMD, also called neovascular AMD, affects approximately 15 percent of people with the disease, according to the American Academy of Ophthalmology. It occurs when abnormal blood vessels grow beneath the macula in a process called macular neovascularization. These vessels are fragile and prone to leaking blood and fluid into the retinal layers.
This leaking distorts the structure of the retina and can cause rapid, severe central vision loss. A protein called vascular endothelial growth factor, or VEGF, drives the growth of these abnormal vessels. Although less common than dry AMD, wet AMD accounts for a large share of serious vision loss from the disease.
AMD usually develops gradually, with changes in the retina often occurring before any symptoms appear. Early AMD may involve small drusen, subtle pigment shifts, and mild thinning of retinal tissue. The disease often begins in one eye and may eventually affect both.
Not everyone with early AMD will progress to advanced stages, but without regular monitoring, meaningful vision loss can occur before a person notices any change. This is why early detection matters so much.
Who Is at Risk for AMD?
Several factors increase the likelihood of developing AMD. Some, like age and genetics, are outside of your control. Others, including smoking and cardiovascular health, can be modified through lifestyle choices and medical care.
Age is the single greatest risk factor for AMD. The disease is uncommon before age 50 and becomes significantly more prevalent with each passing decade. The biological aging process leads to cumulative wear on retinal cells and the supporting structures of the eye. Over time, the eye's ability to remove waste products and maintain healthy blood flow to the macula gradually declines.
Smoking is the most consistently identified modifiable risk factor for AMD. Current smokers face two to three times the risk of developing AMD compared to nonsmokers, according to the American Academy of Ophthalmology, and the risk increases with heavier or longer-term smoking.
Smoking damages blood vessels, reduces oxygen delivery to retinal tissue, and increases oxidative stress on delicate retinal cells. Quitting smoking at any age lowers AMD risk over time and is one of the most protective decisions a person can make for their eye health.
People with a family history of AMD face a significantly higher risk of developing the disease themselves. Researchers have identified several genes associated with AMD, including genes tied to the complement system, which is part of the body's immune and inflammatory response. If a parent or sibling has AMD, your own risk is meaningfully elevated.
Genetic factors may influence how the body manages inflammation and clears cellular waste within the retina. Sharing your family history with your retina specialist helps guide decisions about how closely to monitor your eyes and when to begin preventive measures.
Several cardiovascular risk factors are also linked to a higher likelihood of developing AMD. Conditions that reduce blood flow or promote inflammation can affect the delicate blood vessels that nourish the retina. These include:
- High blood pressure, which can damage the small vessels supplying the retina
- High cholesterol, which may contribute to drusen formation beneath the macula
- Heart disease, which is associated with reduced circulation to the eye
- Obesity, which promotes systemic inflammation that can affect retinal health
Managing these conditions through lifestyle changes and working with your primary care provider may help lower AMD risk or slow its progression.
AMD is more prevalent among people of Caucasian and European descent than among other racial groups, according to the National Eye Institute. Women are also at somewhat higher risk, in part because they tend to live longer on average. That said, AMD can affect anyone regardless of race or gender, and regular eye care is beneficial for all adults as they age.
Recognizing the Signs and Symptoms
AMD can be completely silent in its early stages, which makes routine eye exams essential. As the disease advances, certain visual changes may appear that are important to recognize and report promptly.
In the early stages, AMD may cause no noticeable changes in vision at all. Drusen can accumulate and retinal tissue can begin to thin without any awareness on your part. This is one of the most compelling reasons to schedule regular comprehensive eye exams, particularly after age 50. A retina specialist can detect AMD well before symptoms develop.
As AMD advances, certain visual changes may appear. Recognizing these early and reporting them promptly can make a significant difference in how well vision can be preserved. Common symptoms include:
- Distortion or warping of straight lines, such as doorframes or text on a page
- A blurry, gray, or dark spot in the center of your vision
- Colors that appear less vivid or washed out
- Difficulty reading, even with your current corrective lenses
- Trouble recognizing familiar faces
- Gradual or sudden loss of central vision in one or both eyes
Any new or worsening visual change should be evaluated without delay. Sudden changes in particular require urgent attention.
An Amsler grid is a simple self-monitoring tool that resembles graph paper with a dot at the center. By covering one eye and focusing on the center dot, you can check whether the surrounding lines appear straight, even, and unbroken. Wavy, missing, or distorted lines may indicate changes in the macula.
Our retina specialists recommend regular home use of an Amsler grid for patients already diagnosed with early or intermediate AMD. Any new distortions should be reported to our office right away, as they may signal a transition from dry to wet AMD, which requires prompt evaluation and treatment.
How AMD Is Diagnosed
Accurate diagnosis requires a thorough eye examination combined with specialized imaging. Our retina specialists use several diagnostic tools to evaluate the macula, determine the type and stage of AMD, and guide treatment planning.
A dilated eye exam is the foundation of AMD diagnosis. Eye drops widen the pupils so a retina specialist can examine the macula and retina in close detail. The specialist looks for drusen, pigment changes, fluid or blood beneath the retina, and areas of thinning or cell loss. This exam can reveal AMD before any symptoms develop, making it the most important first step.
Optical coherence tomography, or OCT, creates detailed cross-sectional images of the retina's individual layers. This painless, non-invasive test allows our specialists to measure retinal thickness with precision and detect fluid buildup, drusen, swelling, and areas of geographic atrophy. It takes only a few minutes and is used for both initial diagnosis and ongoing monitoring.
OCT angiography, an advanced variation of the test, can image the retinal blood vessels in detail without requiring an injection of dye, offering additional information in certain cases.
Fluorescein angiography is used to evaluate blood vessel activity in and beneath the retina. A safe dye is injected into a vein in the arm, and a specialized camera photographs the retina as the dye passes through the blood vessels. Leaking or abnormal vessels associated with wet AMD appear clearly on the resulting images.
This test helps our retina specialists confirm the presence of wet AMD, locate the affected vessels, and determine the most appropriate course of treatment.
Depending on your individual situation, our specialists may also use wide-field retinal imaging, indocyanine green angiography (a dye-based test that highlights deeper choroidal vessels), or ophthalmic ultrasound. These tools provide a more complete picture of the retina and choroid, the blood vessel layer beneath the retina, helping ensure a thorough and accurate evaluation.
Treatment Options for AMD
Treatment for AMD depends on the type and stage of the disease and how it is progressing. While there is currently no cure, available treatments can slow AMD, preserve central vision, and in some cases improve it when started early and maintained consistently.
Anti-VEGF injections are the standard treatment for wet AMD. These medications block vascular endothelial growth factor, the protein that triggers abnormal blood vessel growth beneath the macula. By suppressing that growth and preventing leakage, anti-VEGF treatment can stabilize central vision and, in some patients, improve it.
Several anti-VEGF medications are currently available, including aflibercept (Eylea), ranibizumab (Lucentis), faricimab (Vabysmo), bevacizumab (Avastin), and brolucizumab (Beovu). Each has a different dosing schedule and benefit profile. Treatment typically begins with more frequent injections to gain control of the disease, with the schedule adjusted over time based on your response.
Two FDA-approved treatments are available for geographic atrophy, the advanced form of dry AMD. Pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay) are both given as intravitreal injections (injections directly into the eye) and work by targeting parts of the complement system, a branch of the immune response involved in the destruction of retinal cells.
Clinical studies have shown that both medications can meaningfully slow the expansion of geographic atrophy lesions. They do not restore vision that has already been lost, but they offer a way to slow further progression. Your retina specialist will discuss whether these treatments are appropriate for your situation.
The Age-Related Eye Disease Study 2 (AREDS2) found that a specific combination of vitamins and minerals may help reduce the risk of intermediate dry AMD progressing to advanced stages. The AREDS2 formula includes vitamin C, vitamin E, lutein, zeaxanthin, zinc, and copper. These supplements are available over the counter.
AREDS2 supplements are not a treatment for wet AMD and do not reverse vision loss that has already occurred. They are most beneficial for people with intermediate dry AMD or advanced AMD in one eye. Your retina specialist can advise whether they are right for you based on the stage of your disease.
AMD is a long-term condition that requires consistent follow-up. For patients with early or intermediate dry AMD, regular visits allow our specialists to detect progression early and intervene promptly if the disease converts to wet AMD. For patients receiving injections, ongoing appointments are used to assess how well treatment is working and to adjust the schedule as needed.
Staying engaged with your retina care over time is one of the most effective ways to preserve as much vision as possible.
Living Well with AMD
An AMD diagnosis requires adjustments, but many people continue to live active and fulfilling lives. Lifestyle choices, available support resources, and a proactive approach to care all play an important role in the long term.
Certain lifestyle habits may reduce AMD risk or slow its progression. Quitting smoking is the single most impactful change you can make. Other steps that support retinal and vascular health include:
- Eating a diet rich in leafy greens, colorful fruits, and fish
- Maintaining a healthy body weight
- Exercising regularly
- Managing blood pressure and cholesterol in partnership with your primary care provider
- Wearing sunglasses that block ultraviolet (UV) light when outdoors
These habits support overall eye health and complement the treatment your retina specialist recommends.
If AMD has caused significant central vision loss, low vision rehabilitation can help you make the most of your remaining sight. Low vision specialists can recommend magnifying devices, adjustable lighting, large-print materials, screen readers, and other electronic tools that support daily independence.
Many people with AMD continue to manage daily life comfortably with the right combination of support and adaptive strategies. Asking your care team about low vision services is a valuable step if your vision has been affected.
A diagnosis of AMD can bring feelings of anxiety, frustration, or grief. These reactions are a completely normal response to a significant health concern. Talking with family members, connecting with an AMD support group, or speaking with a mental health counselor can help.
Staying informed about your condition and actively participating in treatment decisions can provide a meaningful sense of control throughout your care.
When to See a Retina Specialist
Understanding when to seek care and how urgently is an important part of managing AMD well. Both routine monitoring and urgent symptoms call for different but equally important responses.
Because early AMD often causes no symptoms, regular comprehensive eye exams are essential starting at age 50. Adults with additional risk factors, such as a family history of AMD, a history of smoking, or cardiovascular conditions, may benefit from more frequent screenings.
Early detection gives our retina specialists the opportunity to monitor your disease closely and begin treatment at the right time, which is one of the most effective ways to protect central vision over the long term.
Certain vision changes can signal a rapid worsening of AMD or another serious retinal problem requiring same-day evaluation. Contact a retina specialist immediately or seek emergency care if you experience any of the following:
- A sudden increase in floaters (spots, strings, or shapes drifting across your vision)
- New or worsening flashes of light in one or both eyes
- A curtain, shadow, or dark area appearing or moving across your field of vision
- Sudden loss of central vision in one eye
These symptoms can indicate conversion from dry to wet AMD, a retinal tear, or a retinal detachment. Prompt evaluation and treatment in these situations can significantly affect how well vision can be preserved.
Frequently Asked Questions
These answers address common questions about living with AMD, making decisions about care, and knowing when to act.
There is currently no guaranteed way to prevent AMD, even with an ideal lifestyle. However, consistent healthy habits, including not smoking, managing cardiovascular risk factors, and eating a nutrient-rich diet, can meaningfully reduce your risk. If you already have early or intermediate dry AMD, AREDS2 supplements and regular monitoring are practical tools for slowing further progression. The earlier the disease is identified, the more options exist to protect your vision.
Complete blindness is not a typical outcome of AMD. The disease targets central vision while leaving peripheral side vision intact. Even in advanced stages, most people retain enough surrounding vision to move around and be aware of their environment. With today's anti-VEGF treatments for wet AMD, many patients are able to maintain functional central vision for daily activities. Outcomes are closely tied to how early treatment begins and how consistently it continues over time.
Drusen and geographic atrophy represent different stages along the dry AMD spectrum rather than two separate diseases. Drusen are deposits that form beneath the retina and serve as an early marker of AMD, but their presence does not guarantee that severe vision loss will follow. Geographic atrophy is the advanced stage in which retinal cells in the macula have permanently died and cannot be replaced. The pace of progression from drusen to geographic atrophy varies considerably from person to person and is not inevitable.
Injection frequency is individualized and evolves over time. For wet AMD, anti-VEGF treatment typically starts with monthly injections for the first few months to bring the disease under control. After that, many patients move to less frequent dosing, with schedules ranging from every four to sixteen weeks depending on the medication and your response. For geographic atrophy, complement inhibitors are generally given monthly or every other month. Because AMD can reactivate if treatment is paused, most patients receive injections on an ongoing basis, and your retina specialist will adjust the schedule continuously based on your results.
AMD research is highly active, with ongoing investigations into gene therapies, longer-acting anti-VEGF formulations, implantable drug delivery devices, and new targets within the complement and inflammatory pathways. Our practice is involved in clinical research, which may give qualifying patients access to emerging therapies that are not yet widely available. While no existing treatment reverses AMD, the pace of development in this field continues to improve the long-term outlook for people living with the condition.
Optometrists and general ophthalmologists are often the first to detect AMD during routine exams and play a valuable role in referring patients at the right time. However, once AMD has been diagnosed, or if you have significant risk factors such as a strong family history or a previous diagnosis in one eye, evaluation by a fellowship-trained retina specialist provides a deeper level of diagnostic precision and access to the full range of treatment options. Retina specialists focus exclusively on the retina, which means every visit is specifically oriented toward your retinal health and any changes that may need attention.
See the Retina Specialists at New England Retina Associates
At New England Retina Associates, our fellowship-trained retina specialists are committed to providing thorough, compassionate care for patients with AMD and all retinal conditions throughout Connecticut. Whether you have been referred by your eye doctor or are coming to us directly, we are here to help you understand your diagnosis and take the best possible steps to protect your vision. We look forward to partnering with you in your retinal health and being a trusted resource every step of the way.
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