In the centre of the retina lies an area just a few millimetres across: the macula, or “yellow spot”. This is where the sensory cells for sharpness and colour are packed most densely. Everything you look at directly is projected there; the rest of the retina provides outlines and orientation.¹
In age-related macular degeneration (AMD), metabolic waste builds up there and becomes visible as drusen; the supporting layer underneath works less well, and the sensory cells gradually die off. It is an ageing process, not an inflammation.
The most important message first: AMD does not lead to complete blindness. What is affected is central vision — reading, recognising faces, making out price tags. The outer field of vision is preserved: people with advanced AMD can still make out movements, doors and steps. What is lost is sharpness in the centre, not sight as a whole. Even so, AMD can restrict everyday life considerably.
To tell it apart from other conditions: in cataract, the lens becomes cloudy and the image turns dull — something that can be operated on. In glaucoma, the outer field of vision is lost first and the centre stays sharp for a long time: the opposite of AMD. Diabetic retinopathy, in turn, is damage to the blood vessels caused by diabetes.
2. Dry and wet AMD compared
There are two forms. Telling them apart determines the pace, the urgency and how treatable the condition is.²
Feature
Dry AMD
Wet AMD
What happens
By far the larger share of all cases: drusen and cell loss, later widespread atrophy
Less common, but the cause of most severe vision loss: blood vessels grow in and leak
Pace
Slow, often over many years
Fast — deterioration within weeks is possible
First sign
Reading becomes an effort, more light is needed
Straight lines look bent, a grey spot in the centre
Treatment
No established drug treatment; reduce risk factors, regular checks
Anti-VEGF injections (IVOM) — effective, but designed as long-term treatment
Urgency
Check-ups as your doctor advises
With new distortions, see an ophthalmologist within a few days
Table scrolls to the right
Important in practice: dry AMD can turn into wet AMD at any time, and the two eyes can show different forms.
3. Symptoms and early signs
AMD does not hurt. It only makes itself felt through the quality of the image in the centre, often creeping in gradually.
Early signs
More light needed — the reading lamp moves closer and closer to the page.
Distorted vision (metamorphopsia) — door frames or lines of text look wavy. The classic warning sign.
A grey spot in the centre — it always sits right where you are looking and, unlike floaters, does not drift away.
Sudden loss of sharpness within days to weeks.
The articles on blurred vision and visual disturbances help you make sense of things; what is happening in the macula can only be clarified by an examination.
4. The Amsler grid self-test
The Amsler grid is a grid of lines with a dot in the centre. It costs nothing, takes a minute and is the most practical way to notice changes yourself between two doctor's appointments. Eye practices hand it out as a small card.³
Put on your reading glasses, make sure the light is good and hold the grid at reading distance, 30 to 40 centimetres away.
Cover one eye, look steadily at the central dot with the other and check: are the lines straight and the squares the same size? Is an area missing, or is something grey or bent?
Repeat with the other eye — this is crucial, because as long as one eye sees well, the brain makes up for what the other eye is missing.
Note the date and result, once a week on a fixed day. The comparison over time counts for more than any single result.
Distorted lines: do not wait. If lines look wavy, squares seem unequal in size or an area is missing — and this is new — you need to see an eye practice within a few days. This is the typical sign of wet AMD, and the time until the first treatment helps determine how much sharpness of vision remains. On the phone, say explicitly “newly appeared distorted lines”. With a sudden massive loss of vision, a curtain moving in from the side or many new black dots: go to an ophthalmological emergency clinic; see also Visual disturbances.
To put it honestly: the test does not replace an examination. Its value lies in making a deterioration visible between appointments.
5. Risk factors: what you can influence
Why the macula ages earlier in some people is not fully understood. What is accepted is an interplay of age, genes and lifestyle.⁴
Age — the strongest factor and, like your genes, one you cannot change.
Smoking — the most important risk factor you can influence: it raises the risk considerably and speeds up the course. Stopping smoking is worthwhile at any age and is the most effective single step you can take yourself.
Genetics — AMD in parents or siblings is a sign to take seriously; genetic testing, however, is not part of routine care.
High blood pressure — what harms blood vessels also harms the choroid. Well-controlled high blood pressure is part of the picture; for the right technique, see Measuring blood pressure correctly. Excess weight, lack of exercise and eating little fruit and vegetables are also associated with a higher risk, but the evidence is weaker.
Medicines and the retina. According to current knowledge, AMD is not triggered by medicines. There are, however, active substances that can damage the retina — hydroxychloroquine, for example, is known for this. Bring your medication list to your appointment; the basics are in the guide Medication side effects.
6. Diagnosis: the back of the eye and OCT
The diagnosis is made at an eye practice — and it is straightforward, because the macula can be viewed directly and imaged layer by layer.
History and visual acuity: Since when, one eye or both, distorted lines? Smoking, family history, medicines.
Back of the eye: after drops to dilate the pupils, drusen, pigment changes, bleeding and oedema are assessed.
OCT (optical coherence tomography): the key examination — a light scan creates a cross-section through the retina and makes fluid visible, painlessly and within a few minutes.
Angiography: if the wet form is suspected — dye-free by OCT angiography or conventionally with fluorescein.
Do not drive yourself after dilating drops. The pupils stay wide for hours, and vision is blurred and sensitive to glare — plan for someone to accompany you. What else affects fitness to drive is covered under Medications and driving.
7. Treating wet AMD: anti-VEGF injections
In wet AMD, the body's own messenger substance VEGF drives the growth of the abnormal blood vessels. Anti-VEGF medicines block it. They are injected in a very small amount directly into the vitreous body — a procedure known in Germany as IVOM (intravitreal operative drug administration). The leaking vessels and the fluid recede, and visual acuity stabilises in many cases; in some it improves again.⁵
How an injection works
Numbing drops, disinfection, sterile draping — the procedure takes place under operating-theatre conditions.
A lid speculum holds the eye open — for many people the most unpleasant part, rather than the injection.
The injection is given from the side through the white of the eye (sclera) and takes seconds. Most people report pressure, not pain.
Afterwards there is a short check, often with drops. You go home the same day — but not behind the wheel yourself. For one to two days, a gritty feeling, small red patches on the white of the eye and floaters are normal.
Intervals: why it does not stop at one injection
At the start there are several injections at monthly intervals — the loading phase. After that, the rhythm depends on the findings: either treatment is given only when fluid returns, or an injection is given at every appointment and the interval is gradually extended (“treat and extend”). The treating practice sets the schedule with you.
This is long-term treatment, not a one-off cure. Anti-VEGF medicines keep the condition in check; they do not cure it, and treatment usually runs for years at varying intervals. As a rule, the earlier it starts, the more visual acuity is preserved — sensory cells that have died do not come back.
After an injection: report these signs immediately. Increasing pain, a markedly red eye, severe sensitivity to light or worsening vision in the days after the injection are not normal after-effects. They can point to an infection inside the eye (endophthalmitis) — rare, but an emergency. Contact the practice or an ophthalmological emergency clinic straight away, not at your next regular appointment.
Injection appointments and results without a paper chase
brite reminds you of every injection appointment and keeps your history ready for the consultation.
For the dry form there is currently no established drug treatment in Germany that reliably halts its progression. What remains is still more than nothing:
Stopping smoking — the measure with the clearest effect.
Treat vascular risks — get blood pressure, blood lipids and blood sugar under control.
Keep up with check-ups — to spot a transition to wet AMD in good time.
Amsler test and visual aids — an early warning between appointments; make use of magnification and light in good time.
In the advanced stage, patchy areas of retinal tissue are lost — known as geographic atrophy. Active substances that act on the complement system have been approved for this in other parts of the world; according to current information, they are not available in the EU. Asking “Is there anything new?” is legitimate at every check-up. Stay away from promises of a cure that come without proof of effectiveness.
9. Appointments and check-ups as a success factor
With hardly any other condition does the outcome depend so directly on organisation. The medicines are good — what decides your eyesight is more mundane: whether the next appointment is kept. An injection appointment postponed by weeks can let fluid return, and every relapse costs substance. Everyday life works against this: changing intervals of four to twelve weeks, separate appointments for each eye, pure check-ups in between, plus transport services. A scheduling problem — and therefore a solvable one.
Appointment and reminder plan
Enter every appointment with the eye and type (injection or check-up) and set two reminders: one a week before, to arrange the journey, and one the day before, to be safe — see Medication reminders via app.
Keeping a record
After every appointment, note three things: date, eye treated, next interval — plus the Amsler result once a week. This turns into a curve that is worth more in the consultation than any memory.
Medication plan for the eye practice
Bring a complete list to every appointment — including eye drops, over-the-counter medicines and supplements. How to set one up: Create a medication plan.
Three questions for your next appointment. Is the retina currently dry? At what interval will we see each other again? How can I tell at home that I need to come in sooner? There is a template for this under Prepare for a doctor's appointment; for coordinating several practitioners, see Chronic illness in everyday life.
10. Supplements (AREDS): an honest assessment
Hardly any topic in AMD is marketed as heavily as “eye vitamins”. They are based on the AREDS studies of a combination of antioxidant vitamins, zinc and carotenoids. The result in brief: in certain intermediate stages, the combination can lower the risk of progressing to an advanced stage.²,⁴
What does not follow from this is just as important:
Not prevention for everyone. Without AMD, or with only minor early changes, a benefit has not been proven.
Not a treatment for the wet form. An AREDS supplement does not replace an injection, and lost visual acuity does not come back.
Not every “eye vitamin” is an AREDS supplement. Many products contain different amounts or ingredients.
Safety note for smokers and former smokers: no beta-carotene. In studies, high-dose beta-carotene in smokers was associated with an increased risk of lung cancer. That is why, as the combination was developed further, beta-carotene was replaced by lutein and zeaxanthin. If you smoke or have smoked, have the list of ingredients checked at the pharmacy and do not take any product containing beta-carotene without talking to your doctor first. This is not a theoretical risk but the very reason the formula was changed.
Otherwise, too, high-dose supplements are not harmless foods: zinc can irritate the stomach and, in the long term, affect the body's copper balance. If you already take supplements such as vitamin D, keep an eye on the total amounts; the basic rules are in Supplements and medications and Drug interactions. The recommendation is therefore simple: ask your eye practice whether your stage matches the situation that was studied. If not, save your money and put it towards a good reading lamp.
11. Visual aids and everyday life with AMD
Much of what brings back quality of life is not medicine: magnification, contrast and light.
Double the light: a bright, glare-free reading lamp close to the text often achieves more than any magnifying glass.
Magnifying visual aids: from hand-held magnifiers to video magnifiers — try out several systems; fitting them belongs in expert hands.
Digital aids: increase font size and contrast, switch on the read-aloud function, use audiobooks — built in and free.
Contrasts at home: a light chopping board for dark vegetables, coloured markings on cooker knobs.
Practise eccentric viewing: look very slightly past an object to bring it onto a part of the retina that still works — this can be trained in low-vision rehabilitation.
Two points that are rarely asked about: below certain thresholds of visual acuity, you are entitled to a severe disability card (Schwerbehindertenausweis), to state blindness or visual impairment allowance (Landesblindengeld or Sehbehindertengeld) and to having the costs of magnifying visual aids covered. And there are statutory minimum requirements for driving — if your visual acuity declines, this needs to be raised openly.
Amsler test, eye drops, check-up — without having to think about it
A fixed reminder is all it takes to keep the early warning from slipping through the cracks.
No, as a rule AMD does not cause complete blindness. It affects central vision, that is, reading and recognising faces; the outer field of vision is preserved. Advanced stages do restrict everyday life considerably, however, which is why check-ups and timely treatment remain important.
The dry form is more common and progresses slowly over years; there is as yet no established drug treatment for it. In the wet form, abnormal blood vessels grow in and leak, and vision can deteriorate quickly — but it can be treated well with anti-VEGF injections. This is the most important distinction in AMD.
Once a week is usual, each eye separately, with reading glasses and in good light. What matters is not the individual result but the change compared with previous weeks. If lines newly appear distorted or an area is missing, you need to see an eye practice within a few days.
Before the injection, the eye is numbed with drops. Most people describe a feeling of pressure, not pain; many find the lid speculum more unpleasant. For one to two days, a gritty feeling and red patches on the white of the eye are normal. Increasing pain or worsening vision are not, and need to be reported immediately.
A delay of a few days is usually not a problem, but longer breaks can allow fluid to build up again. Lost visual acuity cannot always be regained. So contact the practice straight away and ask for a replacement appointment as soon as possible.
Only to a limited extent. According to the AREDS studies, a specific combination of antioxidants, zinc and carotenoids can slow progression in marked intermediate stages. A benefit as prevention has not been proven, and they do not replace treatment of the wet form. Anyone who smokes or has smoked must not take supplements containing beta-carotene.
gesund.bund.de, the national health portal of the German Federal Ministry of Health: Age-related macular degeneration. Accessed 2026 — German source. gesund.bund.de
Gesundheitsinformation.de, German Institute for Quality and Efficiency in Health Care (IQWiG): Age-related macular degeneration. Accessed 2026 — German source. gesundheitsinformation.de
Professional Association of Ophthalmologists in Germany (BVA): Age-related macular degeneration, Amsler test. Accessed 2026 — German source. augeninfo.de
Joint statement by the German Ophthalmological Society (DOG), the Retinological Society (RG) and the BVA on anti-VEGF therapy in neovascular AMD. Accessed 2026 — German source. dog.org
No more check-ups lost in calendar chaos — with brite
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Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. Newly appeared distorted lines, a grey spot in the centre of your vision or a rapid deterioration in central vision should be checked by an ophthalmologist within a few days; with a sudden severe loss of vision or a painful red eye after an injection, go to an ophthalmological emergency clinic immediately. The Amsler self-test does not replace an examination. The choice of medicine and its dose are always set individually by the treating practice. Last updated: September 2026.
