In Sri Lanka, age-related Macular Degeneration is managed by geriatricss. Age-related macular degeneration (AMD) is the leading cause of irreversible central vision loss in adults over 50 in high-income countries, driven by progressive damage to the macula — the small central region of the retina responsible for fine detail and reading vision. Roughly 200 million people worldwide live with some stage of AMD, and the global burden is projected to reach 288 million by 2040 as populations age.
Age-related macular degeneration (ICD-10: H35.3) is a chronic, progressive degenerative disease of the macula — a 5.5 mm zone at the centre of the retina that contains the highest density of cone photoreceptors and is responsible for sharp central vision, colour discrimination, and reading. The disease begins with the accumulation of yellow lipid-protein deposits called drusen between the retinal pigment epithelium (RPE) and Bruch's membrane, accompanied by oxidative stress, complement-pathway activation, and chronic low-grade inflammation. Two distinct late forms develop: in dry AMD (non-neovascular), areas of RPE and overlying photoreceptors die in expanding patches called geographic atrophy; in wet AMD (neovascular), abnormal choroidal blood vessels grow through Bruch's membrane into the subretinal space, leaking fluid and blood that scar the macula within weeks if untreated. AMD is staged by the AREDS classification as early, intermediate, or late based on drusen size, pigment changes, and presence of atrophy or neovascularization.
The key symptoms of Age-related Macular Degeneration are: Gradual blurring of central vision in one or both eyes, most noticeable when reading small print, threading a needle, or recognizing a familiar face across a room., Straight lines appearing wavy, bent, or broken — a symptom called metamorphopsia, often first noticed when looking at door frames, window grids, or the Amsler grid given out by eye clinics., A dark, blurred, or empty patch in the centre of vision (central scotoma) that persists when the eye is moved, distinguishing it from a floater., Reduced ability to read in dim light and slower adaptation when moving from a bright room to a dim one, an early functional sign before standard visual acuity drops., Colours appearing less vivid or washed out, especially reds and yellows that depend on macular cones., Difficulty with high-contrast tasks such as recognizing road signs at dusk or distinguishing similar facial features., Sudden central vision loss or a new grey patch over several days — strongly suggests new wet AMD and requires same-week retinal review..
AMD is diagnosed clinically by a retinal specialist or comprehensive ophthalmologist using dilated fundus examination supported by multimodal retinal imaging. History elicits central blurring, metamorphopsia, scotoma, and difficulty with reading or face recognition; Amsler grid testing in the clinic and at home gives an immediate functional check. Dilated examination identifies drusen (size and number), pigmentary changes, geographic atrophy, subretinal fluid, haemorrhage, or fibrosis. The cornerstone imaging test is spectral-domain or swept-source optical coherence tomography (OCT), which resolves the retinal layers at 5-micron precision and detects subretinal or intraretinal fluid, drusenoid pigment epithelial detachments, and atrophic loss of the outer retinal bands. OCT angiography (OCTA) non-invasively visualizes choroidal neovascular networks without dye injection. Fundus autofluorescence maps geographic atrophy, and conventional fluorescein angiography is reserved for atypical cases where the diagnosis or activity of CNV is unclear. Indocyanine green angiography is added when polypoidal choroidal vasculopathy is suspected. Staging follows the AREDS scale (early, intermediate, late dry, late wet). The 2020 American Academy of Ophthalmology Preferred Practice Pattern for AMD recommends OCT and dilated examination at every visit, monthly home Amsler grid monitoring, and prompt referral to a retinal specialist within 1-2 weeks of any new metamorphopsia or scotoma in patients with intermediate AMD because of the time-critical window for anti-VEGF treatment in newly active neovascular disease.
Outcomes vary dramatically by stage and treatment. Early AMD has an excellent prognosis — most patients never progress to late disease in their lifetime, and routine monitoring is sufficient. Intermediate AMD carries a 5-year progression risk of 15-25% to late AMD, reduced to roughly 11-19% with AREDS2 supplementation. Wet AMD treated promptly with anti-VEGF preserves driving and reading vision in approximately 90% of patients at 12 months and 70-80% at 5 years in real-world registries; untreated, central vision typically drops below 20/200 within 3-6 months. Geographic atrophy progresses inexorably without treatment, expanding at roughly 1.5-2.6 mm² per year and reaching the foveal centre after a median of 2.5 years; complement inhibitors slow this rate by 14-22% but do not reverse vision loss. Peripheral vision is preserved at every stage of AMD, meaning legal blindness from this condition rarely means total loss of sight — patients can almost always orient themselves and walk independently. Adherence to treatment, regular monitoring, and low-vision rehabilitation are the strongest predictors of functional independence.
A retinal specialist should be involved when there is intermediate or late AMD, any sign of metamorphopsia or new central scotoma, suspected wet AMD on OCT, or geographic atrophy being considered for complement inhibitor therapy. Comprehensive ophthalmologists and optometrists manage early AMD and provide ongoing monitoring between specialist visits. Same-week retinal review is essential for any new symptom suggesting wet AMD, because anti-VEGF treatment within 2 weeks of conversion preserves substantially more vision than delayed treatment.
Find specialists →For wet AMD treated with anti-VEGF, fluid on OCT typically resolves over 1-3 injections (4-12 weeks), with measurable visual acuity improvement in 4-8 weeks. Treatment is then maintained indefinitely at intervals of 4-16 weeks depending on individual response, often using a treat-and-extend protocol. Most patients require ongoing injections for many years; sudden cessation usually leads to fluid recurrence and vision loss within 3-6 months. For geographic atrophy, complement inhibitors slow progression over years but do not produce noticeable short-term visual change. Visual rehabilitation typically yields functional gains within 8-12 weeks of starting low-vision services.
Aerobic exercise such as walking, cycling, or swimming for at least 150 minutes weekly is associated with lower AMD incidence and progression in observational studies. Resistance training twice weekly supports overall cardiovascular and metabolic health. There are no exercise restrictions specific to AMD, but patients on anti-VEGF injections should avoid eye trauma in the first 24-48 hours after injection.
Look for board-certified retina or vitreoretinal subspecialists, fellowship-trained in medical retina, with high-volume experience in intravitreal injections (most retinal specialists perform 50-200 injections weekly). Ask whether the practice has OCT, OCT angiography, and access to fluorescein angiography on site, and whether they offer treat-and-extend protocols. For geographic atrophy, ask specifically about pegcetacoplan and avacincaptad pegol experience. Continuity matters — AMD is a multi-year condition where the same retinal specialist tracking your scans yields the best outcomes.
Medically reviewed by AIHealz Medical Editorial Board · May 12, 2026
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