Understanding AMD Progression

AMD is a progressive disease, meaning it develops and worsens over time. The rate of progression varies significantly between individuals—some people remain in the early stages for years, while others may advance more quickly. Understanding the stages of AMD helps patients and their families know what to expect, what to watch for, and when treatment may be needed.

Regular monitoring by an eye care professional is essential at every stage, as early intervention can make a significant difference in visual outcomes.

Stages of AMD

Stage What Happens Symptoms
Early AMD Small to medium drusen deposits under the retina; minimal RPE changes Usually none; detected during eye exam
Intermediate AMD Medium to large drusen; pigmentary changes in the retina Mild blurriness; difficulty in low light; may need more light for reading
Late Dry AMD Geographic atrophy: gradual breakdown of light-sensitive cells and RPE in the macula Noticeable central vision loss; difficulty reading and recognizing faces
Late Wet AMD Abnormal blood vessels grow under retina, leaking blood and fluid Rapid central vision loss; straight lines appear wavy; dark spots in vision

Early detection is critical. People with early or intermediate AMD may not notice any vision changes, but an eye care professional can identify the disease during a comprehensive dilated eye exam. The earlier AMD is caught, the more options are available to slow its progression.

Early AMD

In early AMD, small yellow deposits called drusen form beneath the retina. These drusen are typically small to medium in size (less than 125 micrometers). At this stage, there is usually no vision loss.

What to Know

  • Most people with early AMD do not know they have it
  • Diagnosis is typically made during a routine dilated eye exam
  • No treatment is needed at this stage, but monitoring is important
  • Lifestyle changes (diet, exercise, not smoking) may help slow progression
  • Your doctor may recommend regular follow-up exams every 6–12 months

Intermediate AMD

Intermediate AMD is characterized by medium to large drusen deposits and/or pigmentary changes in the retina. Some people begin to notice mild symptoms at this stage, while others may still have no noticeable vision changes.

What to Know

  • Vision may be slightly blurry, especially in dim lighting
  • You may need brighter light for reading and close work
  • The AREDS 2 supplement formula has been shown to reduce the risk of progressing to late AMD by approximately 25%
  • Regular monitoring with OCT imaging is typically recommended
  • Home monitoring with an Amsler grid may be advised

AREDS 2 Supplement Formula

The Age-Related Eye Disease Study 2 (AREDS 2) identified a specific combination of vitamins and minerals that can slow the progression from intermediate to late AMD:

Nutrient Daily Amount
Vitamin C 500 mg
Vitamin E 400 IU
Lutein 10 mg
Zeaxanthin 2 mg
Zinc (as zinc oxide) 80 mg
Copper (as cupric oxide) 2 mg

AREDS 2 supplements are specifically formulated for people with intermediate AMD or late AMD in one eye. They are not intended for people with early AMD or those without the disease. Always consult your ophthalmologist before starting any supplement regimen.

Late AMD

Late AMD comes in two forms, both of which cause significant central vision loss:

Late Dry AMD (Geographic Atrophy)

In geographic atrophy, the light-sensitive cells (photoreceptors) and the retinal pigment epithelium (RPE) in the macula gradually break down and die. This results in a slowly expanding area of vision loss.

  • Vision loss progresses gradually over months to years
  • Creates a growing blind spot in central vision
  • Both eyes may be affected at different rates
  • New complement inhibitor treatments (pegcetacoplan, avacincaptad pegol) are now FDA-approved to slow progression

Late Wet AMD (Neovascular)

Wet AMD occurs when abnormal blood vessels grow from the choroid layer beneath the retina (choroidal neovascularization). These fragile vessels leak blood and fluid, causing rapid damage to the macula.

  • Can cause rapid and severe vision loss within days to weeks
  • Straight lines may appear wavy or distorted
  • Dark or empty areas appear in the center of vision
  • Treatable with anti-VEGF injections that can stabilize or improve vision

Urgent: If you experience a sudden change in vision—such as wavy lines, a dark spot, or rapid blurring—seek immediate care from your eye doctor. Wet AMD can cause permanent damage if not treated promptly. Early treatment with anti-VEGF injections can significantly improve outcomes.

Treatments for AMD

While there is currently no cure for AMD, several treatments can slow progression and, in some cases, improve vision:

Anti-VEGF Injections

Anti-VEGF (vascular endothelial growth factor) therapy is the primary treatment for wet AMD. These medications are injected directly into the eye to block the growth of abnormal blood vessels and reduce fluid leakage.

  • Ranibizumab (Lucentis) — FDA-approved for wet AMD
  • Aflibercept (Eylea) — FDA-approved, may allow longer intervals between treatments
  • Bevacizumab (Avastin) — Used off-label; comparable efficacy at lower cost
  • Faricimab (Vabysmo) — Dual-action therapy targeting both VEGF-A and Ang-2

Treatment typically requires regular injections, initially monthly, with intervals adjusted based on response. Many patients experience stabilized or improved vision with consistent treatment.

Complement Inhibitors (for Geographic Atrophy)

New FDA-approved treatments for geographic atrophy (late dry AMD) work by inhibiting the complement system, part of the immune response involved in retinal cell damage:

  • Pegcetacoplan (Syfovre) — Intravitreal injection given monthly or every other month
  • Avacincaptad pegol (Izervay) — Intravitreal injection given monthly

These treatments slow the rate of geographic atrophy growth but do not reverse existing damage.

Photodynamic Therapy (PDT)

PDT uses a light-activated drug (verteporfin/Visudyne) injected into the bloodstream. A special laser is then directed at the abnormal blood vessels in the eye, activating the drug to seal the vessels.

  • Less commonly used today due to superior results with anti-VEGF therapy
  • May be used in combination with anti-VEGF for certain cases
  • Useful for specific subtypes of wet AMD (e.g., polypoidal choroidal vasculopathy)

Treatment decisions should be made in consultation with a retinal specialist or ophthalmologist who can evaluate your specific condition and recommend the most appropriate therapy. Treatment plans are individualized based on the type, stage, and response patterns of your AMD.

Living with AMD

A diagnosis of AMD does not mean complete vision loss. Many people with AMD continue to live independently and maintain a good quality of life with the right support and resources.

Low Vision Resources

Vision Rehabilitation

Vision rehabilitation specialists can help you learn techniques and strategies to make the most of your remaining vision. Services may include:

Emotional Support

Vision loss can have a significant emotional impact. It is normal to experience grief, frustration, or anxiety. Consider these support options:

Key Takeaways

  • AMD progresses through stages: early, intermediate, and late (dry or wet)
  • Early and intermediate AMD often have no noticeable symptoms
  • AREDS 2 supplements can reduce the risk of progressing from intermediate to late AMD by about 25%
  • Anti-VEGF injections are the standard treatment for wet AMD and can stabilize or improve vision
  • New complement inhibitor therapies are available for geographic atrophy (late dry AMD)
  • Sudden vision changes require urgent medical attention
  • Low vision resources and rehabilitation services can help maintain quality of life
  • Ongoing research, including blood-based risk assessment, aims to enable earlier detection and intervention