Dry Age-Related Macular Degeneration (AMD): Overview and Management

Dry AMD (geographic atrophy) is the most common form (85–90%) of age-related macular degeneration. It involves progressive loss of retinal pigment epithelium (RPE) and photoreceptors in the macula.

Risk Factors

• Age (>50, steep rise >75).
• Genetics (CFH, ARMS2 variants).
• Smoking (2–4× risk).
• Hypertension, cardiovascular disease.
• Obesity, light iris color, prolonged UV exposure.

Symptoms

• Gradual central vision loss: blurring, difficulty reading, recognizing faces.
• Metamorphopsia (distortion) — less than wet AMD.
• Scotomas (blind spots).

Diagnosis

• Fundus exam: drusen (yellow deposits), RPE changes, geographic atrophy.
• OCT: RPE/choriocapillaris atrophy, drusen volume.
• Amsler grid monitoring.

Management

• AREDS2 supplements: Vitamin C 500 mg, E 400 IU, lutein 10 mg, zeaxanthin 2 mg, zinc 80 mg, copper 2 mg — reduces progression to advanced AMD by ~25%.
• Lifestyle: Smoking cessation, UV protection, cardiovascular health, Mediterranean diet.
• Low vision rehabilitation: Magnifiers, electronic aids, training.
• Emerging: Complement inhibitors (pegcetacoplan, avacincaptad pegol) — FDA-approved for geographic atrophy (2023).

No cure, but progression can be slowed. Regular ophthalmology follow-up essential.