GPAtlas🧭 When to suspect
Age-related macular degeneration (AMD) is the leading cause of certifiable sight loss in people over 65 in the UK. It damages the macula – the central retina responsible for sharp, detailed vision – producing central blur, distortion or a central scotoma while peripheral vision is preserved. For this reason AMD impairs reading, face recognition and driving but does not cause total blindness.
The single most useful primary-care discriminator is tempo. Loss that is gradual over months to years points to dry (non-neovascular) AMD, for which there is no disease-specific treatment. Loss that is rapid over days to weeks, especially with new distortion of straight lines, points to wet (neovascular, active) AMD – a sight-threatening but treatable condition where anti-VEGF therapy works best when started early. The clinical skill is therefore twofold: never miss wet AMD, and support the patient with dry AMD.
| Type | Typical features | Onset & primary-care action |
|---|---|---|
| Early AMD | Drusen ± pigmentary change; often asymptomatic or mild blur | Gradual; community optometry and risk-factor advice – do not refer asymptomatic early AMD for hospital diagnostic tests |
| Late AMD – dry | Geographic atrophy of the macula; progressive central scotoma | Months–years; no disease-specific treatment – low-vision support, certification, self-monitoring |
| Late AMD – wet (active) | Choroidal neovascularisation with haemorrhage or fluid; rapid distortion and central loss | Days–weeks; URGENT referral to a macula service within 1 working day |
NICE additionally recognises late AMD (indeterminate) and late AMD (wet inactive); note that wet inactive AMD must not be labelled ‘dry AMD’. Raise suspicion in anyone over 50 with new central visual symptoms, and recognise the NICE risk factors: older age, AMD in the fellow eye, family history, smoking (the strongest modifiable factor), hypertension, BMI ≥ 30, a diet low in omega-3/6, carotenoids and vitamins or high in fat, and physical inactivity.
Source: NICE NG82
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