Macular Degeneration

🔍 When to Suspect

Older adults (>50) with gradual or sudden central vision loss, distortion (straight lines appearing wavy, known as metamorphopsia), or a dark spot in their vision

From the full topic in The Ocean Library: Macular Degeneration

🧭 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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