What Is Dry Macular Degeneration?

An estimated 20 million people in the United States have age-related macular degeneration (AMD), according to research published in November 2022 in JAMA Ophthalmology.

Dry macular degeneration is the more common type of AMD, accounting for 85 to 90 percent of cases, per the American Macular Degeneration Foundation.

The less-common type of AMD is wet macular degeneration, also known as neovascular AMD.

The cause of dry, or atrophic, macular degeneration is not known, although it’s thought to involve both genetics (it often runs in families) and environmental factors, such as exposure to cigarette smoke and certain health conditions, including obesity and cardiovascular disease.

It most commonly occurs in people older than 60, per the Mayo Clinic. Dry AMD causes vision loss as a result of thinning of the macula — the part of the retina that allows for sharpness and fine detail in seeing what’s straight in front of you.

When the macula deteriorates, activities such as reading, writing, driving, and recognizing faces can become difficult. Vision may fluctuate and be limited at night or in low-light situations.

Dry AMD tends to develop gradually, over the course of years. As it advances, the dry type of AMD can become the wet type of AMD, in which abnormal blood vessels and fluid build up beneath the retina, causing distorted vision. In contrast to dry AMD, the onset of wet macular degeneration is typically sudden and can be severe.

No known cure exists for AMD, but there are steps you can take to slow its progression.

RELATED: What to Eat — and Avoid — if You Have Dry or Wet AMD

The symptoms of dry AMD include:

• Seeing straight lines as bent
• Loss of central vision in one or both eyes
• Difficulty adjusting to low light levels, such as when entering a dimly lit area from a brighter one
• Difficulty reading due to increased blurriness
• Dulling in the intensity or brightness of colors
• Difficulty recognizing faces

AMD doesn’t cause pain, and if only one eye is affected, you may not notice any changes in vision or other symptoms initially, because the healthy eye makes up for vision loss in the other eye, says the BrightFocus Foundation.

Stages of Dry Macular Degeneration

There are three stages of dry AMD: early, intermediate, and late.

Early In the early stage, there will likely be no noticeable vision loss, though a few medium-size drusen — yellow protein deposits under the retina — will be present and can be detected by an eye doctor during a dilated-eye exam.

Small drusen develop with age and are commonly found in people over 50, but medium or larger-size drusen are a sign of AMD.

Intermediate With intermediate AMD, people have large drusen and changes in pigment in the retina. Some people still may not perceive changes in their vision, while others may experience blurriness and find that they need more light for activities such as reading.

Late Advanced, or late, dry AMD is also called geographic atrophy (GA). In this stage, photoreceptors — vision cells — in the retina deteriorate and die, which causes a blind spot. GA can occur in one or both eyes; but if it happens in one eye, it’s likely to develop in the other, according to the BrightFocus Foundation.

Not everyone with AMD will progress to the advanced stage. Risk factors for progression include genetics, as well as poor diet and lack of exercise.

Dry macular degeneration can’t be cured, but certain nutritional and lifestyle changes can keep it from getting worse. AMD occurs less frequently in people who exercise, eat healthfully, and don’t smoke.

According to the American Academy of Ophthalmology (AAO), foods rich in vitamins C and E, zinc, lutein, zeaxanthin, and omega-3 fatty acids are good for eye health. These nutrients are linked to a lower risk for AMD later in life. Recommended foods include citrus fruits, dark-green leafy vegetables, whole grains, fatty fish, vegetable oils, and nuts.

The AAO also notes that people who have AMD or are at risk for it can benefit from a low-glycemic-index diet. The glycemic index ranks how quickly and by how much foods raise blood sugar. A low-glycemic-index diet tends to be high in nonstarchy vegetables and whole or minimally processed grains, and low in processed foods, such as chips and commercially baked goods.

Supplements

A daily combination of certain vitamins and nutritional supplements, now sold as AREDS 2, was shown to be effective in delaying the progression of intermediate AMD to advanced AMD by about 25 percent in two studies from the National Eye Institute. These dietary supplements contain high amounts of substances that occur naturally in the macula.

The ingredients in a daily dose of AREDS 2 (often split into two softgels) are as follows:

• 500 milligrams (mg) of vitamin C
• 400 international units (IU) of vitamin E
• 25 to 80 mg zinc as zinc oxide
• 2 mg copper as cupric oxide
• 10 mg lutein
• 2 mg zeaxanthin

Your ophthalmologist can let you know if taking AREDS 2 supplements might be beneficial in treating your dry AMD. The supplements have not been shown to prevent early AMD from progressing to intermediate AMD.

RELATED: AREDS: The Multivitamin and Mineral Supplement That Can Slow Progression of Macular Degeneration

Injections for Geographic Atrophy

In early 2023, the U.S. Food and Drug Administration (FDA) approved the drug pegcetacoplan (Syfovre) for the treatment of geographic atrophy.

Pegcetacoplan is injected directly into the eye every 25 to 60 days. In studies, the drug reduced the growth of lesions in the retina, thereby protecting a person’s remaining vision. There was no indication that the injections improved patients’ vision.

A second injectable drug for geographic atrophy, avacincaptad pegol (Izervay), was approved in August 2023. In clinical trials, monthly in-eye injections of avacincaptad pegol significantly slowed geographic atrophy progression for most study participants, and caused side effects in fewer than 5 percent.

RELATED: The Latest Treatments for Geographic Atrophy: What You Need to Know

Low-Vision Rehabilitation

Once vision loss occurs with dry AMD, it can be helpful to work with a specialist trained in low-vision rehabilitation. You can learn about techniques and devices — such as magnifiers, electronics that convert text to speech, and useful apps — that can make navigating the world a little easier.

Implantable Miniature Telescopes

A select group of people with advanced dry macular degeneration in both eyes, who meet certain specific requirements, may have an option to improve their vision by implanting a telescopic lens in one eye, according to the Mayo Clinic. These implantable miniature telescopes (IMTs) resemble a very small plastic tube and work by magnifying and projecting images over the still healthy areas of the retina. An eye surgeon can implant the IMT in an outpatient procedure.

The eye with the IMT is then used for central vision, while the nonimplanted eye provides peripheral vision. Post-surgical therapy is needed to retrain the brain to use each eye in this way, explains the AAO.

While the current options for treating dry macular degeneration only slow the course of the deterioration, researchers are looking into the use of stem cells to replace and replenish damaged cells in the back of the eye.

Findings from the first human trial of a stem cell–based retinal implant in 2018 showed the implants to be safe and well tolerated in five patients. Research in this area is ongoing.

American Macular Degeneration Foundation

This nonprofit organization offers information about the disease, tips for living with it, recipes aimed at maintaining good eye health, and a downloadable Amsler chart you can use to check your vision.

National Eye Institute

The NEI website features research news on AMD, along with basics about the disease and its treatment.

American Academy of Ophthalmology

The AAO’s EyeSmart website has written information and videos on macular degeneration, as well as information on low vision rehabilitation.

VisionAware

VisionAware, a part of the APHConnect Center, provides information for people living with vision loss, as well as their families, caregivers, healthcare providers, and social service professionals, on eye diseases and disorders, along with tips for living with blindness or low vision.

BrightFocus Foundation

BrightFocus funds research into macular degeneration and other diseases. Its website has a clinical trials finder, as well as information about the eye disease.

Ophthalmic Edge

Ophthalmic Edge, in partnership with the Association for Macular Diseases, offers resources on adjusting to vision loss and the use of technology with and for vision loss. Its Voices page has personal stories of life with vision loss.