Age-related macular degeneration (AMD) is the leading cause of blindness among older adults in the United States, accounting for 54% of all blindness in white Americans. Nearly 20 million Americans aged 40 and older are living with some stage of AMD, and the risk climbs sharply after age 60. Globally, cataracts cause more blindness overall, but in high-income countries where cataract surgery is widely available, AMD is the primary threat to vision in aging populations.
What AMD Does to Your Vision
AMD damages the macula, the small central area of the retina responsible for sharp, detailed vision. This is the part of your eye you rely on to read, drive, recognize faces, and see fine details. Peripheral vision typically stays intact, so AMD rarely causes total darkness. Instead, it erodes the center of your visual field, making everyday tasks progressively harder.
There are two forms. Dry AMD is far more common, affecting 85 to 90% of people with the disease. It develops slowly as the light-sensing cells in the macula and the supportive tissue beneath them gradually break down. Many people with early dry AMD have no symptoms at all, and the disease can take years to progress. In its late stage, called geographic atrophy, patches of retinal cells die off and central vision deteriorates significantly.
Wet AMD affects only 10 to 15% of people with the disease but is far more dangerous. It happens when abnormal blood vessels grow from beneath the retina and push into the macula. These vessels are fragile and leak fluid or blood, which can distort and destroy central vision within weeks or months if untreated. Wet AMD almost always starts as dry AMD first.
Who Is Most at Risk
Age is the strongest risk factor. AMD is rare before 50, uncommon in your 50s, and becomes increasingly prevalent from 60 onward. Genetics play a major role as well. Researchers have identified specific gene variants, particularly in the complement factor H (CFH) gene, that substantially raise risk. If you carry two copies of the high-risk version of this gene, your odds are significantly elevated compared to someone without it.
But genes don’t act alone. A large observational study tracking more than 160,000 women found that lifestyle habits dramatically amplify or reduce genetic risk. Women who carried two high-risk gene variants and also had a history of heavy smoking, low physical activity, and a diet lacking in fruits and vegetables were more than four times as likely to develop AMD compared to women without genetic risk factors who ate well and exercised regularly. Vitamin D deficiency compounded the effect even further: women with two risk alleles and low vitamin D levels had a 6.7-fold increase in their odds of developing AMD.
Smoking is the single most significant modifiable risk factor. It damages blood vessels throughout the body, including the delicate vasculature supplying the retina. Being white also raises risk relative to other racial groups, though AMD occurs across all populations.
How AMD Ranks Against Other Causes
The picture changes depending on race, ethnicity, and geography. Among Black Americans, cataracts and glaucoma are the leading causes of blindness, not AMD. Among Hispanic Americans, glaucoma tops the list. These differences reflect a combination of genetic susceptibility, access to eye care, and rates of conditions like diabetes that damage vision through other pathways.
Globally, the World Health Organization lists cataracts as the top cause of blindness overall, largely because millions of people in low- and middle-income countries lack access to the straightforward surgery that removes them. In wealthier nations where cataract surgery is routine, AMD and glaucoma dominate. Glaucoma affects about 2.7 million Americans over 40 and ranks as the second or third leading cause of blindness depending on the population, but it progresses differently from AMD, silently destroying peripheral vision rather than central vision.
Catching It Early
Early AMD often produces no noticeable symptoms, which is why regular dilated eye exams after age 50 are critical. An eye care professional can spot the tiny yellow deposits under the retina, called drusen, that signal the disease is developing, sometimes years before you notice any vision changes.
Between appointments, a simple tool called an Amsler grid can help you monitor for progression. It looks like graph paper with a dot in the center. You cover one eye, focus on the dot, and check whether the surrounding lines appear wavy, blurry, or have gaps. Any of those changes, especially new waviness or a blank spot near the center, can indicate the disease is worsening or converting from dry to wet AMD. Marking abnormal areas on the grid over time helps track whether things are stable or changing.
The shift from dry to wet AMD can happen suddenly. If straight lines start looking bent, if a dark or empty spot appears in the center of your vision, or if colors seem less vivid than they used to, those warrant a prompt visit to an eye specialist rather than waiting for your next scheduled exam.
Slowing Dry AMD With Nutrition
There is no cure for dry AMD, but a specific combination of nutritional supplements has been proven to slow its progression in people with intermediate or advanced disease. The formula, developed through a large clinical trial sponsored by the National Eye Institute, is known as AREDS2. It contains vitamin C (500 mg), vitamin E (400 IU), zinc (80 mg), copper (2 mg, added to prevent zinc-related copper deficiency), lutein (10 mg), and zeaxanthin (2 mg).
Among people who had the lowest dietary intake of lutein and zeaxanthin, those who took the supplement had a 26% lower risk of progressing to advanced AMD. The updated AREDS2 formula replaced beta-carotene from the original version with lutein and zeaxanthin, which proved both safer (beta-carotene raises lung cancer risk in smokers) and more effective, reducing progression risk by 18% compared to the older formula. These supplements are widely available over the counter, typically labeled as “AREDS2” eye vitamins. They are not beneficial for people with no AMD or only very early-stage disease.
Treating Wet AMD
Wet AMD, while more aggressive, is also more treatable than it was a generation ago. The standard treatment involves injections of medication directly into the eye that block a protein called VEGF, which drives the growth of those abnormal leaking blood vessels. This sounds alarming, but the eye is numbed first, and most patients describe the procedure as uncomfortable rather than painful.
Treatment typically begins with a loading phase of injections given monthly for the first three months. After that, the schedule becomes individualized based on how your eye responds. Some people need injections every month or two indefinitely, while others can stretch intervals to every few months. The key metric is whether fluid is accumulating in or under the retina, which doctors check at each visit using imaging scans.
These treatments don’t restore vision that has already been lost, but they can stabilize or even improve vision in many cases. Before these medications became available in the mid-2000s, wet AMD almost inevitably led to severe central vision loss. Now, with consistent treatment, many people maintain functional reading and driving vision for years. The biggest challenge is adherence: the injections need to continue for as long as the disease is active, and skipping appointments can allow the abnormal vessels to leak again and cause irreversible damage.
Reducing Your Risk
You cannot change your age or your genes, but the modifiable risk factors for AMD are the same ones that matter for heart disease and overall health. Not smoking, or quitting if you currently do, is the single most impactful step. Regular physical activity matters too. The research on women with genetic risk found that even light exercise, roughly 10 hours per week of activities like walking or housework, was associated with meaningfully lower odds of developing AMD.
A diet rich in dark leafy greens (which supply lutein and zeaxanthin naturally), fruits, vegetables, and fish provides the nutrients most strongly linked to macular health. Maintaining adequate vitamin D levels appears to be particularly important for people with genetic susceptibility. And comprehensive dilated eye exams, starting at 50 for most people and earlier if you have a family history, remain the best way to catch AMD before it takes a noticeable toll on your vision.