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Eyes & Vision

Age-Related Macular Degeneration (AMD)

Age-related macular degeneration damages the macula and therefore central vision; suspected late wet active AMD needs urgent macular-service referral, OCT and prompt anti-VEGF treatment, while dry AMD needs risk-factor advice, self-monitoring, low-vision support and clear safety-netting.

In a nutshell

AMD affects central vision. Dry AMD causes drusen, atrophy and gradual loss; wet active AMD causes new distortion, central blur or scotoma from neovascular fluid/haemorrhage. Suspected wet active AMD needs referral to a macula service within 1 working day, OCT and treatment within 14 days of referral when eligible. Anti-VEGF is repeated according to OCT and vision; dry AMD needs risk-factor support, self-monitoring and low-vision care rather than a promised supplement cure.

Classic presentation

An older adult has gradual central reading/face-recognition difficulty, or new wavy straight lines, micropsia or a grey central patch over days to weeks with relatively preserved peripheral vision.

Key points

  • AMD causes central visual loss; peripheral vision may remain useful but driving and daily function can still be unsafe.
  • New metamorphopsia, micropsia or a blurred/grey central patch suggests wet active AMD and needs urgent macular referral.
  • OCT is the key first macular-service test; FFA is used when OCT and examination do not exclude neovascular disease.
  • NICE recommends referral normally within 1 working day and treatment within 14 days of referral to the macular service when anti-VEGF is indicated.
  • Anti-VEGF controls wet active disease but needs repeated OCT/visual monitoring and does not reverse established scar or atrophy.
  • NICE has not made a firm routine recommendation for AREDS2 supplements; discuss products with the eye team and do not present them as a cure.

First-line investigation

Visual acuity and fundus examination for visual change, followed by urgent macular-service OCT when wet active AMD is suspected; FFA only if OCT does not exclude neovascularisation.

Management

Recognise and refer suspected wet active AMD

  • New distortion, micropsia, central blur/grey patch or rapid central visual change warrants urgent macula-service referral, normally within 1 working day.1,6

Use OCT and selective FFA

  • The macular service should perform OCT; use FFA when clinical examination and OCT do not exclude neovascular disease, not as a routine first test when OCT is reassuring.1

Start anti-VEGF promptly when eligible

  • Offer intravitreal anti-VEGF for eligible wet active AMD, with treatment as soon as possible and within 14 days of referral to the macular service; agent and regimen follow current specialist/NHS arrangements.1,3,4

Monitor both eyes and treatment response

  • Use OCT for both eyes during wet active monitoring, reassess if vision declines despite stable OCT, and make switching/stopping decisions jointly with the macular service.1,3

Support dry AMD and reduced vision

  • Stop smoking, support healthy cardiovascular risk care and regular sight tests, discuss uncertain supplement evidence, and refer for low-vision rehabilitation/certification when function is affected.1,7,2

Safety-net visual and injection changes

  • Report new distortion, blurred/grey patches or micropsia quickly; after injection, worsening pain/redness/photophobia or vision loss needs immediate ophthalmology/eye-casualty advice.1,5

Exam traps

  • Wet active AMD referral is urgent within 1 working day but does not normally require 999 emergency referral.
  • Do not call wet inactive AMD simply ‘dry AMD’; recurrence remains possible and monitoring may be required.
  • Do not order routine FFA if examination and OCT exclude neovascular disease.
  • Amsler/self-monitoring helps detect change but does not replace fundus examination, OCT or prompt referral.
  • NICE does not support treating dry AMD as though AREDS2 is a proven routine cure; discuss uncertain supplement benefit and formulation risks.
  • Increasing pain, redness, photophobia or worsening vision after an intravitreal injection suggests endophthalmitis or another complication and needs immediate ophthalmology advice.

Illustrations

Drusen in dry age-related macular degenerationColour fundus photograph showing numerous yellow drusen clustered around the macula, a feature of dry age-related macular degeneration. The image should be labelled as a visual example rather than a substitute for slit-lamp examination or OCT.National Eye Institute, Wikimedia Commons · Public domain

Key sources

  1. NICE NG82, Age-related macular degeneration (NG82)Updated 23 Jan 2018
  2. NHS, Treatments for age-related macular degeneration (NHS AMD treatment)Updated 22 Jan 2025
  3. NICE TA800, Faricimab for treating wet age-related macular degeneration (TA800)Updated 29 Jun 2022
  4. NHS England, commissioning recommendations for medical retinal vascular medicines (NHS England medical retinal vascular medicines, version 3)Updated 16 Mar 2026
  5. Cambridge University Hospitals, Intravitreal injection of anti-VEGF (CUH anti-VEGF injection patient guidance)
  6. NICE QS180, Serious eye disorders: treatment of late wet active AMD (QS180)Updated 23 Jan 2018
  7. NICE NG82, research recommendation on antioxidant and zinc supplements (NG82 research recommendation 1)Updated 23 Jan 2018

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.