Dry age-related macular degeneration (AMD) is an eye disease that can gradually worsen over time, affecting vision as it progresses. Doctors classify dry AMD in three stages in order to track its progress. Monitoring the disease helps your doctor provide timely treatment to prevent late-stage dry AMD, which can cause significant vision loss.

If you notice any vision problems in one or both eyes or if an existing symptom worsens, consult an eye care specialist immediately.

Here’s more about the three stages of dry AMD and what you can do to reduce your risk of developing it.

1. Early-Stage Dry Age-Related Macular Degeneration

All age-related macular degeneration starts as early-stage dry AMD. Located in the central part of the retina, the macula is responsible for sharp focus and clear straight-ahead vision. Dry AMD is not related to having dry eyes. Rather, the term “dry AMD” is used to distinguish it from wet AMD, another type of AMD that can develop in advanced cases.

As people age, waste material accumulates in cells beneath their macula. Similar to other parts of the body, eye cells metabolize sugar, oxygen, and other nutrients, releasing waste that contains cholesterol. This cholesterol builds up under the macula in yellow deposits known as “drusen.” While small drusen deposits are normal with aging, people with dry AMD accumulate enough to damage the macula and photoreceptors.

People with early dry AMD often have no obvious symptoms. Dry AMD is painless and doesn’t typically affect vision in its early stage. Drusen can be detected in routine eye exams that involve dilating the pupils to examine the retina, located in the back of the eye. Eye doctors can identify drusen because they appear as yellow spots. Imaging tests such as optical coherence tomography (OCT) may also be used to diagnose early dry AMD.

Dry AMD is painless and doesn’t typically affect vision in its early stage.

Although dry AMD can develop in one or both eyes, it almost always affects both. It is possible to have AMD at different stages in each eye. People with dry AMD are often provided with tools to monitor their vision at home.

Subclinical Dry AMD

Some medical experts identify subclinical dry AMD as a stage that occurs before early dry AMD. “Subclinical” means there is no clinical evidence of the condition. In subclinical dry AMD, drusen are not yet detectable. It is diagnosed in some people who have difficulty adjusting their eyes to darkness, a condition known as “dark adaptation loss.”

2. Intermediate-Stage Dry Age-Related Macular Degeneration

Dry AMD can develop slowly over several years. If you’ve been diagnosed with early dry AMD, your eye doctor will monitor you for signs of intermediate dry AMD. If your optometrist has detected dry AMD, you may need to be monitored by an ophthalmologist (medical doctor who specializes in eye disease).

Intermediate dry AMD may or may not have obvious symptoms. If, while monitoring your condition, your eye doctor finds large drusen deposits and damage to retinal pigment epithelium (RPE) cells, it indicates that the disease has progressed from early-stage AMD to intermediate AMD.

Symptoms of intermediate dry AMD are often mild, affecting the central vision, and may include:

• Blurry or distorted areas in vision
• Less contrast or less color in vision
• Difficulty seeing in dim light

When visual acuity is affected by intermediate dry AMD, it only impacts central vision — what you see when you look straight ahead. This can make activities such as reading, driving, or recognizing faces difficult, especially if AMD affects both eyes.

Intermediate dry AMD affects central vision, making activities such as reading, driving, or recognizing faces difficult.

Treatment for Intermediate-Stage Dry AMD

Currently, the main treatment for intermediate dry AMD is a combination of vitamins, minerals, and antioxidants in nutritional supplements known as the AREDS2 formula. (“AREDS2” stands for “Age-Related Eye Disease Study 2.”) The formula contains a mixture of:

• Vitamin C
• Vitamin E
• Lutein
• Zeaxanthin
• Zinc (zinc oxide)
• Copper (cupric oxide)

AREDS2 formula can’t repair damage that has already occurred in the eye. However, research in the Age-Related Eye Disease Study 2 found it can slow the progression of the disease in some people and help prevent further vision loss. The formula is available over the counter without a prescription.

Research has not found the AREDS2 formula to prevent early-stage dry AMD from progressing. If your doctor advises you to take it, they’ll provide instructions on how often you should take it. AREDS2 formula has replaced the original AREDS formula, which was originally recommended for dry AMD. The original formula contained beta-carotene, which was found to increase the risk of lung cancer in people who smoke. Researchers have found the newer AREDS2 formula to be not only safer but also more effective than its predecessor.

Always discuss dietary supplements, such as vitamins or minerals, with your doctors. Some supplements may interact with other medications you are taking in dangerous ways or may cause unwanted side effects.

3. Late-Stage Dry Age-Related Macular Degeneration

When the condition advances to late-stage dry AMD, vision is affected more severely. Advanced-stage AMD — also known as “atrophic macular degeneration” or “geographic atrophy,” is characterized by areas of damage in the eye that resemble islands on a map when examined through an eye specialist’s lens.

In late- or advanced-stage AMD, areas of drusen are larger, and damage to photoreceptor cells cause more severe loss of central vision, such as:

• Blurriness and blankness or dark spots in the central vision
• Straight lines appearing crooked or wavy
• Increased difficulty seeing in low light
• Words disappearing as you read

AREDS2 formula is used in the treatment of late-stage AMD to help prevent further loss of vision. Advanced-stage dry AMD is the leading cause of legal blindness worldwide.

Advanced dry AMD causes dark or blank spots in the central vision. It’s the leading cause of legal blindness worldwide.

Some Cases of Dry AMD May Develop Into Wet AMD

Advanced dry AMD progresses to wet AMD in 10 percent to 15 percent of cases. “Wet” refers to abnormal blood vessels beneath the macula that leak blood and fluid. The condition is also known as “neovascular AMD.” It should be treated as soon as possible to help prevent damage to the eye from progressing quickly.

Treatment options for the wet form of AMD:

• Anti-VEGF drugs that are injected into the eye
• Photodynamic therapy
• Laser photocoagulation therapy

Reduce Your Risk of Developing Dry AMD

You have a higher risk of developing dry AMD if you have a family history of AMD or are over the age of 60. Those are risk factors you can’t control, but there are steps you can take to reduce your risk of developing this condition and protect your eye health:

• Quit smoking. Smoking raises your risk of AMD two to three times.
• Maintain a healthy weight. People diagnosed with obesity (having a body mass index, or BMI, of 30 or more) have double the risk of AMD.
• Manage hypertension (high blood pressure), which increases the risk of AMD by 50 percent.
• Make regular exercise and physical activity a part of your daily life.
• Eat a healthy diet. Make sure to include dark leafy green vegetables and fish high in omega-3 fatty acids, such as salmon and sardines. Avoid packaged foods which have unhealthy omega-6 fatty acids.

Get regular eye exams to help ensure that you’re properly monitored if you develop AMD or any other eye problems. Talk to your doctor as soon as possible if you think you may be having eye or vision issues.

Talk to Others Who Understand

On myAMDteam — the social network for people with age-related macular degeneration and their loved ones — members come together to ask questions, give advice, and share their stories with others who understand life with AMD.

Has your dry age-related macular degeneration progressed since you were diagnosed? How has your condition been monitored? Share your experience in the comments below, or start a conversation by posting on your Activities page.