Wet and Dry, One Eye or Both...I Am SO Confused!

If you ARE confused about all the terms that get tossed around for age-related macular degeneration (AMD), you are NOT alone! I hope I can help you understand the basic terms and point you to more information if you want it.

Some of these terms are used with other types of macular degeneration, but for now, we’re focusing on just AMD.

Links

I have tried to keep the explanations as simple as possible, but there are more details available on the MacularDegeneration.net site. Have you seen the text in our articles that are underlined and in a different color than the rest of the text? They’re called links or hyperlinks. If you click on/tap/choose a link, you’ll be automatically taken to a page on the site where can learn more.

Don’t be intimidated by all the links below. Just choose the ones for which you want more information.

Types of AMD

There are two basic types (sometimes the words ‘forms’ or ‘kinds’ are used) of AMD: dry and wet. Why dry and wet, what does that refer to? Simply put, in wet AMD, there is blood or fluid under the macula. In dry, there is not.

Let's dig deeper into some terms you have heard that refer to these types:

• You may see wet AMD referred to as exudative - think of the word 'exude' which can mean 'to release liquids.'
• Dry is referred to as atrophic - think of the word 'atrophy' which here means 'degeneration.'
• Another term used for wet AMD is neovascular AMD. 'neo' means 'new', 'vascular' refers to the blood vessels under the macula.
• CNV is yet another term used which stands for choroidal neovascularization where 'choroidal' means 'under the choroid.' The choroid is a layer of tissue that separates the blood supply from the cells that make up the macula.

Stages of AMD

There are 3 stages of dry AMD: early, intermediate, and advanced dry. Advanced dry AMD is called geographic atrophy (GA) because when your eye specialist looks at some of the tests you had done, they can see ‘islands’ of vision loss.

The stages are often referred to early/intermediate dry and advanced. Both geographic atrophy and wet AMD are advanced stages.

Finding out the stages

Your eye specialist is the one who determines the stages based on their testing and examination. The examination includes asking you what your symptoms are.

You can have different stages of AMD in each eye. You can have one eye with no AMD and the other with AMD.

It all starts as dry

You may have been diagnosed first with wet AMD. However, all AMD starts as dry. Some people don't go to an eye specialist until their vision has noticeably declined. The symptoms of early and intermediate dry AMD can be subtle and may go unnoticed.³

Wet AMD can't go back to dry

If you have wet AMD, has your retinal specialist said that it is now 'dry'? The word 'dry' here actually means 'dried up' referring to the bleeding under the macula the occurs in wet AMD. The disease unfortunately does not go back to an earlier stage.³ Once an eye has wet AMD, it is considered to always be wet. It can, however, become stable. Another way to look at it is wet AMD is active or inactive.

Drusen which is seen with early and intermediate dry AMD can 'disappear' if the disease progresses to wet AMD or it can remain. Some eye specialists may refer to any remaining drusen as evidence that the eye is also in the intermediate dry stage.  It's confusing, I know, and misleading! Unfortunately, the disease hasn't reversed.⁴

Wet and dry in the same eye?

There is one exception to the related question, "Can I have wet and dry in the same eye?" It is possible for someone to have both wet AMD and geographic atrophy which is advanced dry AMD in the same eye. It is rare, but it does happen.⁴

Another use of 'dry'

There's another use of the word 'dry' that gets confusing. I've had people tell me, "I have a dry eye." Most of the time they mean dry AMD, but sometimes they mean dry eye syndrome which isn't related to AMD at all. A person can have dry eye syndrome and dry AMD in the same eye at the same time.

Not everyone develops wet AMD

If you are in a macular degeneration group or follow a Facebook page like ours, you may find that wet AMD is the most often discussed stage. If you have early or intermediate AMD, you might think you will eventually have wet AMD and need those dreaded-by-some eye injections. That is not the case, actually:

• 85-90% of those with AMD have dry AMD. 10-15% have wet AMD.² You may see slightly different %s.
• With early dry AMD, your risk of developing wet AMD is 10%.¹
• With intermediate AMD, your risk of developing wet AMD is 10-15%.¹
• I'm not sure what the % of risk is to advanced dry AMD/geographic atrophy. Still looking! Some sources include geographic atrophy with wet AMD in the "your risk of developing..."

Why do we hear more about the wet stage? It's because of its 'treatment burden.' That means that to treat it requires regular injections which are stressful to some. There may be a cost associated for the injection and perhaps for the travel. Some people travel quite far.

Got it?

I hope I've helped with some of the basics of the types and stages of AMD. If you have any questions, please ask. Instead of what's in the title of this article, can you now say, "Wet and Dry, One Eye or Both...I Got This!"?

Editor's Note: As of August 2023, 2 drugs known as complement inhibitors — Syfovre® and Izervay™ — have been approved by the US Food and Drug Administration (FDA) to treat geographic atrophy (GA).