Age-related Macular Degeneration (AMD)

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  • Difference between dry and wet AMD
  • Dry
    • early AMD: multiple small drusen <63um or some medium-sized drusen 63-125um
    • intermediate AMD: at least 1 large drusen >125um or ≥ 20 medium-sized drusen 63-125um.
    • Advanced AMD with geographic atrophy
  • Wet
    • Advanced AMD with choroidal neovascularisation (CNV)


  • Central visual loss, metamorphopsia, reading difficulties


  • Visual acuity reduced, Amsler grid with metamorphopsia
  • Fundoscopy
    • Dry: Drusen, pigmentary abnormalities, atrophy
    • Wet: retinal haemorrhages (sign of activity), macular edema, CNV membrane
  • OCT
    • Dry: Drusen, retinal pigment epithelial detachments (PEDs), Atrophy
    • Wet: intra-/subretinal fluid, CNV membrane
  • Fluorescence angiography: gold standard for the detection of wet AMD
    • Angio-OCT as an alternative / additional examination in case of unclear findings

Differential Diagnosis


  • Dry AMD: smoking cessation, optimisation of cardiovascular risk factors, vitamin supplementation according to AREDS-2 (see below), low-vision counselling
  • Wet AMD: intravitreal anti-VEGF injections (e.g. Lucentis, Eylea), usually according to a treat & extend regimen

Vitamin supplementation according to AREDS-2

  • Original AREDS-2 Formula
    • Vitamin C 500 mg
    • Vitamin E 400 IU
    • Zinc 80 mg
    • Copper 2 mg
    • Lutein 10 mg
    • Zeaxanthin 2 mg
  • Indication (in AREDS-2 study)
    • Patients aged 50 to 85 with bilateral intermediate AMD or advanced AMD in 1 eye
  • Supplements with AREDS-2 Formula
    • e.g. Bausch & Lomb: PreserVision AREDS 2 or Protina Trophosan Visiobalance


  • Dry AMD: 6-12 months with Amsler grid self-monitoring
  • Wet AMD: initially monthly, extension of injection interval as soon as stable (various regimens possible)


  • EyeWiki Age-related macular degeneration
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)
  • The Age-Related Eye Disease Study 2 (AREDS2) Research Group*. Lutein + Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration: The Age-Related Eye Disease Study 2 (AREDS2) Randomized Clinical Trial. JAMA. 2013;309(19):2005–2015. doi:10.1001/jama.2013.4997
  • AREDS2 Research Group; Chew EY, Clemons T, SanGiovanni JP, Danis R, Domalpally A, McBee W, Sperduto R, Ferris FL. The Age-Related Eye Disease Study 2 (AREDS2): study design and baseline characteristics (AREDS2 report number 1). Ophthalmology. 2012 Nov;119(11):2282-9. doi: 10.1016/j.ophtha.2012.05.027. Epub 2012 Jul 26.