Dry and Wet AMD: Understanding Your Diagnosis
How Dry AMD Develops
Dry AMD is the more common form of the disease. It develops gradually over time as the macula thins and small protein deposits accumulate beneath the retina, often without causing noticeable symptoms in the early stages.
In dry AMD, tiny yellow deposits called drusen build up beneath the retinal pigment epithelium (a supportive cell layer under the retina). Over time, these deposits and gradual thinning of the macula disrupt the cells responsible for central vision. This process is slow and may take years before vision changes become apparent.
Dry AMD is classified into three stages that help guide monitoring and treatment decisions.
- Early dry AMD features small drusen with no noticeable vision symptoms
- Intermediate dry AMD involves medium to large drusen and possible mild blurring, especially in low light
- Late dry AMD, known as geographic atrophy, occurs when patches of retinal tissue break down and create permanent blind spots in central vision
Not everyone with early dry AMD will progress to the later stages, but regular monitoring is essential to track any changes.
Vision changes from dry AMD are typically slow and subtle, developing over months to years. You may notice that you need brighter light for reading, have difficulty adjusting from bright to dim environments, or experience mild blurriness at the center of your vision. Because these changes happen gradually, routine eye exams allow your specialist to detect progression that you may not yet notice on your own.
How Wet AMD Develops
Wet AMD is less common than dry AMD but is responsible for the majority of severe vision loss associated with the disease. It develops more suddenly and requires urgent attention when symptoms appear.
Wet AMD occurs when abnormal new blood vessels grow from beneath the retina into the macula, a process called choroidal neovascularization. These fragile vessels leak blood and fluid, causing rapid and often significant damage to central vision. Although wet AMD represents a smaller percentage of all AMD cases, its impact on vision can be severe when left untreated.
Unlike dry AMD, wet AMD can cause noticeable vision loss within days to weeks. Common symptoms include straight lines that appear wavy or distorted (a symptom called metamorphopsia), a dark or blank spot in the center of your vision, and colors that appear faded or washed out. These changes can affect one eye while the other remains unaffected, which makes them easier to overlook unless you test each eye separately.
Any stage of dry AMD can convert to wet AMD at any time. When this happens, the disease is always considered late-stage. Daily monitoring with an Amsler grid (a simple checkerboard-pattern chart used to detect distortion in central vision) helps you identify the sudden waviness or new dark spots that signal conversion. If you notice any of these changes, contact your eye care provider the same day for urgent evaluation rather than waiting for your next scheduled appointment.
Treatment Options for Dry AMD
While there is currently no cure for dry AMD, several approaches can slow progression and help preserve vision depending on the stage of the disease. Your specialist will recommend a plan tailored to where your AMD stands today.
For patients with intermediate dry AMD, a specific formulation of vitamins and minerals known as AREDS2 supplements has been shown to reduce the risk of progressing to advanced AMD by approximately 25 percent. These supplements contain vitamins C and E, lutein, zeaxanthin, zinc, and copper. Your specialist can confirm whether your stage of AMD warrants starting them, as they are not recommended for early dry AMD.
For late dry AMD (geographic atrophy), two FDA-approved complement inhibitors are available: pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay). Both are delivered by injection into the eye and work by slowing the rate at which geographic atrophy expands. Neither treatment restores lost vision or improves visual acuity, but slowing lesion growth may help preserve functional vision for longer. Patients receiving these treatments are monitored closely because they carry an increased risk of conversion to wet AMD.
Photobiomodulation, a non-invasive light-based therapy, has received FDA authorization for use in dry AMD. Clinical trial data from the LIGHTSITE III trial showed improved visual acuity in intermediate dry AMD patients compared to a sham treatment group. Your specialist can discuss whether this option is appropriate for your specific situation.
Treatment Options for Wet AMD
Wet AMD is a medical urgency. Prompt treatment gives you the best chance of stabilizing or even improving your vision. The sooner treatment begins after symptoms appear, the better the likely outcome.
The primary treatment for wet AMD is anti-VEGF therapy, which involves injecting medication directly into the eye to stop the growth of abnormal blood vessels. Anti-VEGF stands for anti-vascular endothelial growth factor, referring to the protein that triggers abnormal vessel growth. Available medications include ranibizumab, aflibercept, bevacizumab, and faricimab. Many patients stabilize their vision or experience some improvement with timely and consistent treatment. Delaying anti-VEGF therapy can result in permanent central vision loss.
Faricimab is a newer type of medication called a bispecific antibody, meaning it targets two different proteins involved in abnormal vessel growth: VEGF-A and angiopoietin-2. For some patients with wet AMD, faricimab allows dosing intervals of up to four months, reducing the overall treatment burden compared to older medications that require more frequent injections. Your specialist will determine which medication and schedule is most appropriate based on how your eye responds to treatment.
Lifestyle Strategies for Both Forms of AMD
Alongside medical treatment, certain lifestyle habits have evidence supporting their role in slowing AMD progression and reducing the risk of severe vision loss. These strategies apply to both dry and wet AMD.
Smoking is one of the most significant modifiable risk factors for AMD. It roughly doubles the risk of developing advanced AMD and accelerates progression in both dry and wet forms. Quitting smoking at any age provides benefit, and your primary care provider can connect you with resources to help.
A Mediterranean-style diet rich in dark leafy greens, yellow and orange vegetables, and fish is supported by evidence for reducing oxidative stress and inflammation that contribute to macular damage. Regular aerobic exercise and good control of blood pressure and cholesterol also play a role in supporting retinal health over time.
All AMD patients are encouraged to perform daily Amsler grid checks at home. To use the grid, hold it at reading distance, cover one eye, and focus on the center dot. Report any new waviness, bent lines, missing areas, or dark spots to your eye doctor right away. Catching dry-to-wet AMD conversion early gives you the best opportunity for effective treatment before permanent damage occurs.
Frequently Asked Questions
These are some of the questions our patients ask most often about dry and wet AMD. If your situation is not covered here, our specialists are glad to help clarify your specific diagnosis and care plan.
Yes, it is possible to have different forms or stages of AMD in each eye at the same time. You can also develop wet AMD on top of existing dry AMD within the same eye. Because each eye can behave independently, your specialist monitors both eyes separately at every visit. This is also why you should test each eye individually when using your Amsler grid at home.
Anti-VEGF injections are specifically designed to block the abnormal blood vessel growth that defines wet AMD. They do not address the drusen buildup or tissue atrophy involved in dry AMD. If you have intermediate dry AMD, AREDS2 supplements are the evidence-supported option. If you have geographic atrophy, your specialist may discuss complement inhibitor injections, which work through a completely different mechanism than anti-VEGF medications.
Wet AMD is considered urgent. Because the abnormal blood vessels can cause rapid, significant damage within days to weeks, starting anti-VEGF treatment as soon as possible after symptoms appear is critical. If you notice sudden distortion, a new dark spot, or rapid blurring in either eye, contact our office the same day rather than waiting for your next scheduled visit. Time is vision with wet AMD.
AMD affects central vision only. The peripheral, or side, vision is not damaged by this disease. Most people with AMD retain enough side vision to move around safely, but tasks that depend on sharp central vision, such as reading, recognizing faces, and driving, become increasingly difficult as the disease progresses. Preserving as much central vision as possible is the focus of all AMD treatment.
The frequency of monitoring visits depends on your specific stage of AMD and whether you are currently receiving treatment. Patients with early dry AMD may need exams every six to twelve months, while those with intermediate AMD, active wet AMD, or geographic atrophy typically need more frequent visits. Your specialist will establish a monitoring schedule based on your individual case and adjust it as your condition changes.
Complement inhibitors (pegcetacoplan and avacincaptad pegol) are not appropriate for every patient with geographic atrophy. Your specialist will consider factors such as lesion size, location, rate of progression, and your overall eye health before recommending these treatments. It is also important to understand that an increased risk of converting to wet AMD has been observed in patients on these medications, which is why close monitoring at each visit is essential.
Visit Retina Associates of Greater Philadelphia
Whether you have been recently diagnosed with AMD or have been managing it for years, our team at Retina Associates of Greater Philadelphia is here to provide expert, personalized retina care across our five convenient locations. We are committed to helping patients throughout the Philadelphia region and Southern New Jersey preserve their vision through accurate diagnosis, proven treatments, and ongoing support. We welcome you to schedule an appointment and take the next step in protecting your sight.
Dr. Lili Kaplan has outstanding medical credentials. I am so happy this retina specialist group was recommended to me.
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Dr. Kleiner is an excellent doctor. He takes his time with the examination and explains everything in layman's terms.
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