Macular Degeneration, Age-Related
BASICS
DESCRIPTION
- Age-related macular degeneration (AMD) is the leading cause of central vision loss in older adults.
- Loss of reading, driving at night, recognizing faces or expressions
- Classified as:
- “Dry”/Nonexudative or atrophic, such as drusen or macular pigmentary changes
- “Wet”/Exudative or neovascular age-related macular degeneration (nAMD)
EPIDEMIOLOGY
- nAMD form is more common in White people.
- Predominant sex: female
Incidence
- “Dry”/Nonexudative: 80–85% of cases; favorable prognosis
- “Wet”/Exudative: 15–20% of cases; accounts for 80% of severe vision loss
Prevalence
- People 65 to 74 years old: 11%
- People ≥75 years old: 27.9%
ETIOLOGY AND PATHOPHYSIOLOGY
- Atrophic/nonexudative
- Drusen and/or pigmentary changes in the macula is “hallmark.” Drusen are deposits of hyaline material between the retinal pigment epithelium (RPE) (a pigment layer underneath the retina that normally helps remove metabolic by-products from the retina) and Bruch membrane (the limiting membrane between the RPE and the choroid).
- Visible light can result in the formation and accumulation of metabolic by-products in the RPE, a pigment layer underneath the retina that normally helps remove metabolic by-products from the retina. Excess accumulation of these metabolic by-products interferes with the normal metabolic activity of the RPE and can lead to the formation of drusen.
- nAMD
- nAMD stage generally arises from the atrophic stage.
- In type 1 neovascularization, breaks in Bruch membrane allow choroidal neovascular membranes (CNVMs) to grow into the sub-RPE space. This corresponds to occult CNVMs. Fluid leakage and bleeding can produce a vascularized serous or fibrovascular RPE detachment.
- In type 2 neovascularization, the CNVM passes through the RPE and is located in the subretinal space; typically appears as a lacy or gray-green lesion. This corresponds to classic CNVM.
- Type 3 neovascularization, also known as retinal angiomatous proliferations (RAPS), the neovascularization develops from the deep capillary plexus of the retina and grows downward toward the RPE.
- Polypoidal choroidal vasculopathy (PCV) is a subtype of nAMD and often presents with multiple, recurrent serosanguineous RPE detachments. An RPE detachment is also known as a pigment epithelial detachment (PED). Optical coherence tomography (OCT) features of PCV include multiple PEDs, sharply peaked PED, notched or multilobulated PED, and a hyperreflective ring surrounding an internal hyporeflective lumen beneath a PED.
- nAMD stage generally arises from the atrophic stage.
Genetics
Complement factor H (CFH) and age-related maculopathy susceptibility 2 genotypes are important susceptibility genes for AMD.
RISK FACTORS
- Advanced age
- Obesity
- Hypertension
- Hyperlipidemia
- Cigarette smoking
- Chlamydia pneumoniae infection
- Family history
- Excess sunlight exposure
- Blue or light iris color
- Hyperopia
- Short stature
GENERAL PREVENTION
- Omega-3 and Omega-6 fatty acids
- Ultraviolet (UV) protection for eyes
- Routine ophthalmologic visits
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Citation
Domino, Frank J., et al., editors. "Macular Degeneration, Age-Related." 5-Minute Clinical Consult, 34th ed., Wolters Kluwer, 2026. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816290/all/Macular_Degeneration__Age_Related.
Macular Degeneration, Age-Related. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2026. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816290/all/Macular_Degeneration__Age_Related. Accessed July 26, 2025.
Macular Degeneration, Age-Related. (2026). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (34th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816290/all/Macular_Degeneration__Age_Related
Macular Degeneration, Age-Related [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2026. [cited 2025 July 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816290/all/Macular_Degeneration__Age_Related.
* Article titles in AMA citation format should be in sentence-case
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T1 - Macular Degeneration, Age-Related
ID - 816290
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816290/all/Macular_Degeneration__Age_Related
PB - Wolters Kluwer
ET - 34
DB - Medicine Central
DP - Unbound Medicine
ER -