Dry Macular Degeneration: Understanding and Protecting Your Central Vision

Age is the strongest risk factor for dry AMD. The condition is most common in people over age 55, and the risk increases significantly after age 65. Genetics also play an important role. People with a close family member who has AMD are at higher risk. Specific gene variants, including those in the complement factor H (CFH) gene and the ARMS2 gene, have been linked to a meaningfully increased likelihood of developing AMD.

Several factors within your control can influence whether AMD develops or progresses more quickly.

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

Dry AMD is more commonly diagnosed in white Americans than in other racial groups. Women tend to be diagnosed more often than men, in part because women generally live longer. That said, AMD can develop in anyone, and no group is fully protected from this condition.

The Age-Related Eye Disease Study 2 (AREDS2) was a large clinical trial that found a specific combination of vitamins and minerals could reduce the risk of progressing from intermediate to late AMD by about 25 percent. The AREDS2 formula includes vitamin C, vitamin E, lutein, zeaxanthin, zinc, and copper. These supplements are available over the counter and are specifically recommended for people with intermediate dry AMD or late AMD in one eye.

It is important to understand that AREDS2 supplements do not reverse existing damage or restore lost vision. They are a preventive measure designed to help slow further progression. Your retina specialist can tell you whether these supplements are appropriate for your specific stage of AMD and whether they are safe given your overall health.

Geographic atrophy, the advanced stage of dry AMD, now has FDA-approved treatment options for the first time. Two medications, Syfovre (pegcetacoplan) and Izervay (avacincaptad pegol), belong to a class called complement inhibitors. They work by targeting the complement system, a branch of the immune system that contributes to the destruction of retinal cells in geographic atrophy.

Both medications are given as intravitreal injections, meaning they are injected directly into the eye in a brief office procedure. Syfovre is given every 25 to 60 days, while Izervay is given once per month. Clinical studies showed that both medications significantly reduced the rate at which geographic atrophy expands. These treatments do not restore vision that has already been lost, but they can help preserve the vision that remains. Your retina specialist will determine whether you are a candidate for either treatment.

Making healthy choices is one of the most accessible ways to support your macula over time.

• Stop smoking: This is one of the single most impactful steps for reducing AMD risk and slowing 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 from fish may also be beneficial.
• Exercise regularly: Moderate physical activity has been linked to lower AMD risk.
• Protect your eyes from UV light: Wear sunglasses that block both UVA and UVB rays whenever you are outdoors.
• Manage cardiovascular health: Controlling blood pressure and cholesterol 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 tools such as magnifying lenses, large-print materials, screen readers, high-contrast settings on devices, and specialized lighting. These resources can help people continue to read, use technology, and maintain independence. Your retina specialist can provide a referral if low vision services would benefit you.

Currently, no treatment can reverse the damage caused by dry AMD or restore vision that has already been lost. The focus of care is on slowing progression and protecting the vision that remains. AREDS2 supplements can help people with intermediate AMD reduce their risk of advancing to a late stage. For those who have already reached geographic atrophy, the complement inhibitors Syfovre and Izervay can slow the expansion of cell loss. Research into new approaches is ongoing, and this is an area of active scientific progress.

Not always. Dry AMD can affect one eye before the other, and it may be at a different stage in each eye. It is also possible for one eye to remain in an earlier stage while the other progresses to geographic atrophy or even converts to wet AMD. This is why your retina specialist examines and images both eyes at every visit, even if one eye seems to be doing well. Monitoring both eyes separately is an important part of comprehensive AMD care.

Most people with dry AMD do not lose all of their vision. AMD primarily affects central vision, while peripheral (side) vision is generally preserved even in advanced cases. This means most people retain enough vision to move around safely and perform many daily activities. Low vision rehabilitation can help people with significant central vision loss use their remaining vision as effectively as possible. Your care team can connect you with these services when appropriate.

AREDS2 supplements are generally well tolerated, but they are not right for every person. The earlier AREDS formula contained beta-carotene, which was linked to an increased risk of lung cancer in smokers and former smokers. The AREDS2 formula replaced beta-carotene with lutein and zeaxanthin, which is a safer option for people with a smoking history. Even so, you should talk with your retina specialist and your primary care provider before starting these supplements, particularly if you take other medications or have other health conditions.

Changes in dry AMD are often subtle and develop slowly, which is why home monitoring and regular office visits both matter. Using your Amsler grid daily gives you a practical way to notice changes in central vision between appointments. New blurriness, distortion, or blank areas in the grid are signals to contact your retina specialist right away. At each visit, your doctor will compare OCT and fundus imaging from previous visits to detect any measurable changes, even ones you may not yet notice on your own.

Drusen are the small yellow deposits that accumulate under the retina in early and intermediate dry AMD. Their presence does not guarantee vision loss will occur, but their size and number help predict the likelihood of progression. Geographic atrophy is the late stage of dry AMD, where the retinal cells and the tissue supporting them have actually been lost. This creates permanent areas of vision loss. Geographic atrophy represents a more advanced, irreversible state compared to the earlier stages where drusen are the main finding, and it is the stage where complement inhibitor injections may be considered.