Stages of Age-Related Macular Degeneration (AMD)

Age-related macular degeneration (AMD) is a leading cause of vision loss in older adults. It happens when a part of the retina called the macula weakens. The retina is the light-sensitive tissue in the back of the eye. The macula is the central portion of the retina that processes light signals from directly in the center of your field of view. Thus, AMD can blur your central vision and make it hard to see faces and do close-up work.^1,2

AMD progresses in stages based on the size and amount of yellow deposits under the retina. These yellow deposits are called drusen. During an eye exam, your doctor will dilate your eyes to look for drusen.³

While most people will have some small drusen as a normal part of the aging process and may not cause vision problems, larger, indistinct, or numerous drusen may be a sign of AMD.³

What are the stages of macular degeneration?

There are 3 general stages of AMD: early, intermediate, and advanced. Most people with AMD are in the early or intermediate stages. The stages are based on:^2-6

• Size of drusen under the retina
• Amount of drusen under the retina
• Changes in the retinal pigment epithelium (RPE), which are cells that support the retina

You can have AMD in one eye only or have different stages of AMD in each eye. You may have heard of “dry” and “wet” AMD:^1,3

• Dry AMD follows the early, intermediate, and advanced stages.
• Wet AMD is always considered advanced. Wet AMD is less common, but it can cause sudden and severe vision loss.

Early AMD

Early AMD usually does not cause vision loss. People with early AMD have multiple small drusen, a few medium drusen, or mild RPE abnormalities. Drusen at this stage are about the thickness of a human hair. People with early AMD have a low risk of developing advanced AMD. Only 15 percent of people with small or no drusen at diagnosis develop large drusen within 10 years.^1-4

Intermediate AMD

Recognizing intermediate AMD is important because of the higher risk of developing advanced AMD. Intermediate AMD may cause mild vision loss or blurriness. People in this stage have multiple medium-size drusen or at least 1 large drusen. Abnormal changes in the RPE may also be present.^1,3,4

Advanced AMD

Advanced AMD is also called “vision-threatening AMD.” People with advanced AMD have vision changes in at least one eye. Common vision changes include:^1,4

• Straight lines looking wavy or crooked
• Blurry area in the center of your vision
• Colors seem less bright than before
• Trouble seeing in low lighting

Having advanced AMD in one eye increases your risk of developing advanced AMD in the other eye. There are 2 types of advanced AMD:^2-4

• Advanced dry AMD (also called non-neovascular AMD or geographic atrophy)
• Wet AMD (also called neovascular or exudative AMD)

Advanced dry AMD

In dry AMD, retinal cells sensitive to light gradually die. This interferes with the eye’s ability to sense light. Combined with RPE breakdown, this causes vision loss. Geographic atrophy describes an area where RPE cells have completely died. People with advanced dry AMD often develop wet AMD.^2,3

Wet AMD

While less common than dry AMD, wet AMD is responsible for the majority of severe central vision loss associated with AMD. In wet AMD, abnormal blood vessels develop underneath the retina and leak fluid or blood. Wet AMD can progress quickly, and vision loss can be sudden. It is possible to have signs of both wet and dry AMD in the same eye.^2,3

Progression of AMD

The risk of progressing to advanced AMD depends on many factors. For example, 6 percent of people with large drusen in only one eye develop advanced AMD within 5 years. The risk rises to 26 percent for people with large drusen in both eyes.⁴

Within 10 years, 37 percent of people with medium drusen in one eye develop large drusen. The risk is 71 percent for people with medium drusen in both eyes.⁴

Assessing risk of AMD progression

Your doctor may use a scoring system to assess your risk of developing advanced AMD. The score is based on 2 factors:⁴

• The presence of large drusen
• Pigment changes

You get assigned 1 point for each risk factor in each eye. People with a score of 4 (both factors in both eyes) have the highest risk. People with a score of 0 (no factors in either eye) have the lowest risk.⁴

Using this scoring system, the risk of developing advanced AMD in at least 1 eye is:⁴

• 4 factors – 45 percent at 5 years; 71 percent at 10 years
• 3 factors – 26 percent at 5 years; 53 percent at 10 years
• 2 factors – 9 percent at 5 years; 28 percent at 10 years
• 1 factor – 4 percent at 5 years; 8 percent at 10 years
• 0 factors – 0.5 percent at 5 years; 1.5 percent at 10 years

Diagnosis and treatment

If you have been diagnosed with AMD, talk with your doctor about your risk of progression. This can help you make decisions about treatment and adjust to vision changes. Ask them what treatments are available for your type and stage.¹

Your doctor also will suggest how to maintain your eye health and protect your vision. For example, if you have advanced dry AMD in only one eye, you can take steps to protect your other eye.¹