Dry and wet macular degeneration are two forms of the same disease, but they differ in how they damage your central vision, how fast that damage happens, and how they’re treated. About 80% of people with age-related macular degeneration (AMD) have the dry form, which progresses gradually over years. The wet form is far less common but more serious, capable of causing rapid vision loss in weeks or even days.
How Dry AMD Develops
Dry macular degeneration starts with the buildup of tiny yellow deposits called drusen underneath the retina. These deposits form as the body struggles to clear away waste products from retinal cells. Oxidative damage and problems with fat metabolism in the retina play a role, and immune system proteins found in drusen suggest the body’s own inflammatory response contributes to the buildup. Over time, immune cells migrate into the space beneath the retina and accumulate fatty debris, adding to the problem.
As drusen accumulate, they disrupt the thin layer of cells that nourishes the retina (the retinal pigment epithelium). In early stages, you may not notice any symptoms at all. As the disease progresses to an intermediate stage, you might start seeing slight blurriness or need more light to read. In its most advanced form, dry AMD leads to geographic atrophy, where patches of retinal cells die off entirely, leaving permanent blind spots in your central vision. This progression typically unfolds over many years.
How Wet AMD Develops
Wet macular degeneration occurs when abnormal new blood vessels grow from the layer beneath the retina (the choroid) up into the macula. These vessels are fragile and poorly formed. They leak fluid and blood into and beneath the retina, causing the delicate retinal layers to swell, separate, or become distorted.
This leaked fluid can collect in tiny cysts within the retina or pool between retinal layers, warping the flat surface the eye depends on for sharp vision. The result is often sudden distortion: straight lines appear wavy, objects look the wrong size, or a dark spot appears in the center of your visual field. Unlike dry AMD, which creeps forward slowly, wet AMD can cause noticeable vision loss within days to weeks of the abnormal vessels forming.
Wet AMD almost always begins as dry AMD first. Not everyone with dry AMD will develop the wet form, but the transition can happen at any point, which is why monitoring matters.
Symptoms and How They Differ
The hallmark difference is speed. Dry AMD causes gradual, sometimes barely perceptible changes. You might not realize anything is wrong until you struggle to read fine print or notice that colors look duller. The vision loss tends to affect both eyes, though often unevenly.
Wet AMD announces itself more dramatically. The most characteristic symptom is metamorphopsia, where straight lines look bent or wavy. You might notice a doorframe seems crooked, or the lines on a page of text appear distorted. A dark or blurry patch can develop in the center of one eye’s vision over a short period. Because the change can be sudden, catching it early is critical for preserving sight.
Monitoring at Home With an Amsler Grid
An Amsler grid is a simple tool that looks like graph paper with a dot in the center. It’s one of the most practical ways to catch wet AMD early, especially if you already have dry AMD. To use it, hold the grid about 12 to 15 inches from your face (normal reading distance) while wearing your usual glasses or contacts. Cover one eye and focus on the center dot without moving your gaze.
While staring at the dot, check whether all four corners of the grid are visible, all the lines look perfectly straight, there are no dark or blank areas, and no lines appear blurred or faded. Then repeat with the other eye. If any lines look wavy, broken, or missing, that’s a sign of macular changes that need prompt attention. The grid also helps you show a specialist exactly where in your visual field the distortion is, which points them to the affected area of the macula.
How Each Type Is Diagnosed
Both forms are diagnosed with a dilated eye exam, but a scan called optical coherence tomography (OCT) is especially useful for telling them apart. OCT takes cross-sectional images of the retina, almost like a microscopic ultrasound using light.
In dry AMD, the scan shows drusen as bumps and undulations along the retinal pigment layer. In advanced dry AMD, thinning retinal tissue becomes visible, and the scan’s light penetrates deeper than normal because the damaged tissue no longer blocks it effectively.
In wet AMD, the scan reveals a distinctly different picture. Abnormal blood vessel membranes appear as bright, dome-shaped or nodular formations near the retinal surface. Fluid pockets show up as dark, well-defined cysts within the retina. If blood has leaked beneath the retinal pigment layer, it creates a dense shadow that blocks the scan from seeing deeper structures. These fluid and blood markers are what distinguish active wet AMD from the dry form.
Treatment for Wet AMD
Wet AMD is treated with injections directly into the eye that block a protein called VEGF, which drives the growth of those abnormal blood vessels. Four drugs are commonly used for this purpose. Three of them (ranibizumab, aflibercept, and faricimab) were designed specifically for AMD. A fourth, bevacizumab, was originally a cancer drug but is widely used off-label for AMD around the world.
Injection frequency varies. Older treatments typically require visits every 4 to 8 weeks, meaning 6 to 12 appointments per year. Newer options, including faricimab and a higher-dose version of aflibercept, can extend that interval so some patients need only three to four injections per year. The injections don’t cure wet AMD, but they can stop or slow the leaking vessels and, in many cases, improve vision if started early enough.
Treatment for Dry AMD
For most of its history, dry AMD had no approved treatment beyond nutritional support. That changed in 2023 when the FDA approved pegcetacoplan, the first drug for geographic atrophy (advanced dry AMD). In clinical trials, monthly injections slowed the growth of atrophic lesions by 12% to 22% over the first year, with reductions of 19% to 22% sustained at two years. A second drug, avacincaptad pegol, was also approved for geographic atrophy. These treatments slow progression but do not restore vision that has already been lost.
For people with intermediate AMD, a specific vitamin and mineral formula called AREDS2 is the main evidence-based intervention. It contains vitamin C (500 mg), vitamin E (400 IU), zinc (80 mg), copper (2 mg), lutein (10 mg), and zeaxanthin (2 mg). This combination has been shown to slow the progression from intermediate to advanced AMD. It does not help in early-stage disease, and if both eyes already have late AMD, the benefit is minimal. If you have late AMD in only one eye, the formula can help protect the other eye.
Risk Factors for Both Types
Age is the strongest risk factor, with most cases developing after 55. Genetics play a significant role. Variants in at least three genes (CFH, LOC387715, and HTRA1) roughly double to nearly triple the odds of developing AMD. Having a parent or sibling with the disease meaningfully raises your risk.
Among environmental factors, smoking is the most consistently identified risk factor for progressing to advanced AMD. Other contributors include high blood pressure, obesity, a diet low in leafy greens and fish, and prolonged UV exposure. You can’t change your genetics, but quitting smoking, eating a diet rich in colorful vegetables, and managing cardiovascular health are the most practical steps for reducing risk.
Can Dry AMD Turn Into Wet AMD?
Yes, and this is one of the most important things to understand about the disease. Dry AMD can convert to wet AMD at any stage, though the risk increases as the dry form advances. The conversion can happen in one eye while the other remains dry, or in both eyes at different times. Because wet AMD causes faster damage, anyone diagnosed with dry AMD should monitor their vision regularly with an Amsler grid and keep up with scheduled eye exams. Early detection of the switch to wet AMD gives treatment the best chance of preserving vision.