Dry Macular Degeneration: Understanding and Protecting Your Central Vision

Age is the strongest known risk factor for dry AMD. The condition becomes increasingly common after age 55, and the risk rises significantly after age 65. Family history also plays a major role. People whose parents or siblings have had AMD face a higher risk themselves. Certain gene variants have been linked to a substantially increased risk of developing the condition.

Several factors within your control can influence the development and progression of dry AMD.

• Smoking: Current smokers are significantly more likely to develop AMD than nonsmokers. Quitting smoking is one of the most impactful steps you can take.
• Diet: A diet low in leafy green vegetables, fish, and antioxidant-rich foods may increase risk.
• Obesity: A higher body weight has been associated with faster disease progression.
• Sun exposure: Prolonged exposure to ultraviolet light may contribute to retinal damage over time.
• Cardiovascular health: High blood pressure and heart disease are associated with increased AMD risk.

Dry AMD is more commonly diagnosed in white Americans than in Black, Hispanic, or Asian Americans, though anyone of any background can develop it. Women are diagnosed with AMD more often than men overall, partly because women tend to live longer. If you have any combination of these risk factors, talk to your eye care provider about when to begin screening and how often to be seen.

The Age-Related Eye Disease Studies (known as AREDS and AREDS2) were large clinical trials that identified a specific combination of vitamins and minerals that can reduce the risk of progressing from intermediate to late AMD. The AREDS2 formula includes vitamin C, vitamin E, lutein, zeaxanthin, zinc, and copper. These supplements are available over the counter and are recommended specifically for people with intermediate dry AMD or late AMD in one eye.

It is important to understand that AREDS2 supplements are not a cure and cannot restore vision that has already been lost. They are a preventive tool meant to slow further progression. Your provider can confirm whether the AREDS2 formula is appropriate for your specific situation.

Two FDA-approved treatments are now available for geographic atrophy, the advanced stage of dry AMD. Syfovre (pegcetacoplan) and Izervay (avacincaptad pegol) are both complement inhibitors, meaning they work by targeting the complement system, a part of the immune response that contributes to retinal cell destruction in geographic atrophy. Both are administered as intravitreal injections, which are injections delivered directly into the eye in a clinical setting.

Clinical trials showed that both treatments slowed the rate at which geographic atrophy expanded compared to no treatment. Like AREDS2 supplements, these medications do not restore lost vision, but they may help preserve the remaining vision by slowing the progression of atrophy. Your provider will determine whether this type of treatment is appropriate for you and, if so, what schedule works best.

The choices you make every day can have a real effect on how AMD progresses. The following lifestyle steps are supported by clinical evidence.

• Stop smoking: Quitting smoking is one of the most effective steps you can take to reduce AMD risk and slow its progression.
• Eat a nutrient-rich diet: Foods high in lutein and zeaxanthin, such as kale, spinach, and eggs, support macular health. Omega-3 fatty acids found in fatty fish may also be beneficial.
• Stay physically active: Regular moderate exercise has been associated with lower AMD risk.
• Protect your eyes outdoors: Wear sunglasses that block both UVA and UVB rays.
• Manage cardiovascular health: Keeping blood pressure and cholesterol in a healthy range supports overall eye health.

For people who have experienced significant central vision loss from advanced dry AMD, low vision rehabilitation can help make the most of remaining vision. Low vision specialists can recommend magnifying glasses, large-print materials, screen readers, high-contrast device settings, and specialized lighting. These tools help many people continue reading, using technology, and maintaining their independence. Your provider can refer you to low vision services when appropriate.

Yes, and this is one of the most important reasons for regular monitoring. Dry AMD can convert to wet AMD at any stage, including early stages. The conversion can happen quickly and may cause more rapid vision loss than dry AMD alone. This is why sudden changes in your vision or Amsler grid results should always prompt an urgent call to your provider rather than a wait-and-see approach.

The current AREDS2 formula is generally considered safer for smokers than the original AREDS formula, which contained beta-carotene. Beta-carotene was linked to an increased risk of lung cancer in current and former smokers, so it was removed from the updated AREDS2 formula and replaced with lutein and zeaxanthin. That said, every supplement decision should be discussed with your eye care provider and primary care provider, especially if you take other medications or have additional health conditions.

Dry AMD primarily affects central vision, not peripheral (side) vision. Most people with the condition do not lose all functional vision. Even in advanced stages, side vision is typically preserved well enough to navigate your environment. Low vision aids and rehabilitation services can help you make the most of your remaining vision and maintain a meaningful level of independence.

These are two different features of dry AMD that appear at different stages. Drusen are small yellow deposits under the retina and are the hallmark of early and intermediate disease. Having drusen does not automatically mean you will lose vision, but their size and number help predict your risk of progressing further. Geographic atrophy, by contrast, is the late stage of dry AMD in which retinal cells and the supporting tissue beneath them have been permanently lost. This cell loss creates lasting blind spots in central vision. Geographic atrophy is the stage where complement inhibitor injections may be considered.

These treatments work by slowing the growth of geographic atrophy, not by restoring vision that has already been lost. Your provider will use repeat imaging, particularly OCT and fundus autofluorescence, to measure the size of the atrophic area over time and compare it to your baseline images. Stable or slower-growing atrophy compared to the expected rate of progression is the goal. Your provider will review these images with you at each visit and explain what the results mean for your care plan.