What is the difference between dry and wet AMD?

Dry AMD (also called geographic atrophy in its advanced form) accounts for about 85–90% of all AMD. It progresses slowly over years as light-sensitive cells in the central retina gradually deteriorate, causing a slowly enlarging blind spot in the centre of vision. Wet (neovascular) AMD accounts for 10–15% of AMD but is responsible for a disproportionate share of severe vision loss because new, leaky blood vessels grow under the retina and can cause rapid central vision deterioration. The key early symptom of wet AMD is metamorphopsia — straight lines appear wavy. This requires same-day or same-week ophthalmology referral.

What are AREDS2 supplements and should I take them?

AREDS2 supplements are a specific combination proven in large clinical trials to slow AMD progression: vitamin C 500 mg, vitamin E 400 IU, lutein 10 mg, zeaxanthin 2 mg, zinc 25–80 mg, and copper 2 mg. They reduce the risk of progressing to advanced AMD by about 25% in people with intermediate AMD or advanced AMD in one eye. They are not recommended for early AMD or general eye health in people without AMD — evidence does not support benefit in these groups. AREDS2 supplements are not PBS-funded and cost roughly $30–60 per month. Smokers must use the AREDS2 formula only — the older AREDS1 formula contains beta-carotene, which increases lung cancer risk in current or recent smokers.

How are wet AMD injections given, and how often?

Intravitreal anti-VEGF injections are administered by an ophthalmologist directly into the vitreous cavity of the eye under local anaesthesia, typically in an outpatient procedure room. The eye is numbed with drops; the injection takes seconds and is usually well-tolerated, though pressure and a brief sting may be felt. After a loading phase (usually 3–4 monthly injections), most patients move to a treat-and-extend schedule where the interval between injections is adjusted based on retinal OCT findings — ranging from 4 to 16 weeks depending on the agent and individual response. Most people require ongoing injections long-term to maintain vision stability.

Can AMD cause total blindness?

AMD affects only the macula — the central 5% of the retina responsible for fine detail vision: reading, recognising faces, and colour perception. Even in advanced AMD, peripheral (side) vision is preserved. AMD does not cause complete blindness. However, the loss of central vision can be severe and profoundly affect independence — reading, driving, face recognition, and watching television. This is an important reassurance for patients newly diagnosed, but it does not diminish the real functional and psychological impact. Low-vision rehabilitation (Vision Australia, Macular Disease Foundation Australia) supports independent living and should be offered as soon as functional impact is present.

What should I do if I notice wavy lines when looking at a door frame or grid?

Metamorphopsia — straight lines appearing wavy, distorted, or missing — is the classic early warning sign of wet AMD. It most commonly develops in someone who already has intermediate dry AMD in one or both eyes. This symptom requires the same day or same week contact with an ophthalmologist or optometrist experienced in macular disease, not a routine GP appointment. Do not wait to see if it resolves. If you have intermediate AMD, check each eye separately on an Amsler grid (available from the Macular Disease Foundation Australia website) once or twice weekly. New distortion on the Amsler grid is the trigger for urgent review.

Age-related macular degeneration

Age-related macular degeneration: the AU general practice approach

By Dr HB Lo, FACRRM Reviewed 1 July 2026 10 min read

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in Australians over 50.

Wet AMD causes sudden central vision distortion and requires urgent anti-VEGF intravitreal injections (PBS-funded). Dry AMD with geographic atrophy progresses slowly; complement inhibitors slow but do not reverse lesion growth.

Smoking is the single largest modifiable risk. AREDS2 supplements reduce progression risk in intermediate AMD. Core GP actions: eye exams from age 50, AREDS2 for the right stage, smoking cessation, and same-week referral for new metamorphopsia or sudden central vision change.

The macula is the central 5-millimetre region of the retina responsible for fine detail vision — reading text, recognising faces, threading a needle, and seeing clearly straight ahead. When it deteriorates, central vision is lost while side vision is preserved.

Age-related macular degeneration (AMD) is the leading cause of irreversible legal blindness in Australians over 50, according to the Macular Disease Foundation Australia (MDFA) and RANZCO. The Blue Mountains Eye Study (CERA) estimates that approximately 17% of Australians over 50 have evidence of early AMD, with roughly one in seven affected overall. Prevalence rises sharply with age — approximately one in four people over 80 is affected.

AMD splits into two advanced forms with very different clinical trajectories. Dry AMD (geographic atrophy) accounts for 85–90% of all AMD and progresses slowly over years. Wet (neovascular) AMD accounts for 10–15% but disproportionately drives severe visual loss because newly formed, leaky subretinal blood vessels (choroidal neovascularisation) can cause rapid central vision deterioration over days to weeks.

Smoking is the most important modifiable risk factor — roughly doubling to quadrupling the risk of advanced AMD, with some reduction in risk occurring progressively after cessation. Understanding this is central to the GP’s role in AMD management.

A. Core clinical — the AU general-practice framework

Risk factors

Non-modifiable: age (strongest factor — prevalence rises sharply after 75), white European ethnicity, light iris colour, family history of AMD (first-degree relative approximately 3× risk), and genetic variants (CFH Y402H and ARMS2/HTRA1 — routine genetic testing is not recommended in general practice per AAO PPP 2023).

Modifiable: smoking (the most important — strongly recommend cessation at every consultation), hypertension, dyslipidaemia, obesity, diet low in green leafy vegetables and oily fish, and chronic high UV exposure. Aspirin, when indicated for cardiovascular disease, does not meaningfully increase AMD risk per current meta-analysis evidence and should be continued when otherwise appropriate.

Staging

Stage	Retinal findings	Vision	GP action
Early	Small/medium drusen (<125 μm), minor RPE pigment changes	Usually normal	Lifestyle counselling; eye exam every 1–2 yr; AREDS2 not indicated at this stage
Intermediate	Large drusen ≥125 μm and/or definite pigmentary changes	Normal to mild central impairment; metamorphopsia possible	Start AREDS2; annual ophthalmology review; Amsler grid daily self-monitoring
Advanced — dry (geographic atrophy)	Sharply demarcated areas of RPE/photoreceptor loss threatening fovea	Gradual, expanding central scotoma	Pegcetacoplan eligibility with ophthalmologist; low-vision rehab referral; counsel re realistic expectations
Advanced — wet (neovascular AMD)	Choroidal neovascularisation → subretinal fluid, haemorrhage, exudate	Sudden metamorphopsia, central distortion	Urgent ophthalmology — same week for intravitreal anti-VEGF

Symptoms

Metamorphopsia — straight lines (door frames, tiles, text lines) appear wavy or bent; the earliest symptom of wet AMD. Use an Amsler grid for monitoring, testing each eye separately with glasses on.
Central scotoma — a patch of missing or blurred central vision.
Reduced reading vision out of proportion to peripheral sight.
Colour desaturation in advanced disease.
No pain — pain or redness points to a different diagnosis (acute angle-closure glaucoma, uveitis).
Peripheral vision preserved even in end-stage disease — AMD does not cause complete blindness.

Investigations

Visual acuity (Snellen or LogMAR) and near vision — at every review
Fundus examination by optometrist or ophthalmologist — drusen, RPE changes, haemorrhage
OCT macula — gold standard for fluid detection, drusen volume mapping, geographic atrophy extent, and monitoring anti-VEGF response
OCT angiography — non-invasive CNV detection without dye
Fluorescein angiography — reserved for equivocal or classic wet AMD characterisation in specialist setting
Amsler grid — patient-administered at home; instruct every patient with intermediate AMD on correct technique (fixate central dot, cover one eye at a time, look for wavy or missing squares)

B. Evidence — AREDS2, anti-VEGF, and new geographic atrophy treatments

AREDS2 supplementation — what it can and cannot do

The original AREDS trial (2001) established that a specific antioxidant-zinc formula reduced progression to advanced AMD by approximately 25% in people with intermediate or unilateral advanced AMD. The AREDS2 trial (JAMA Ophthalmology 2013) replaced beta-carotene with lutein (10 mg) and zeaxanthin (2 mg) after the CARET and ATBC trials showed beta-carotene increased lung cancer risk in current and recent smokers. AREDS2 efficacy is equivalent to AREDS1, and safe for smokers.

AREDS2 formula (AREDS2 trial, JAMA Ophthalmology 2013): Vitamin C (500 mg), Vitamin E (400 IU), lutein (10 mg), zeaxanthin (2 mg), zinc (25–80 mg), copper (2 mg). Not PBS-funded; costs approximately $30–60/month. Available as Macu-Vision Plus, Lutein Vision Advanced, Ocuvite Adult 50+, and others.

Indications: intermediate AMD, or advanced AMD in one eye (to protect the fellow eye).
Not indicated: early AMD only; no AMD; general eye health supplementation — evidence does not support these uses.

Key prescribing caution: smokers and recent ex-smokers must use the AREDS2 formulation specifically — products still containing beta-carotene (AREDS1 formula) are contraindicated.

Anti-VEGF for wet AMD — established first-line treatment

Intravitreal anti-VEGF injections are the standard of care for wet (neovascular) AMD, administered by ophthalmologists, PBS-funded under Section 100 Authority for eligible patients. Current PBS-listed agents for nAMD in Australia include:

Ranibizumab (Lucentis 0.5 mg) and biosimilar ranibizumab (Ximluci/Ranivisio — PBS-listed 2024)
Aflibercept (Eylea 2 mg; Eylea HD 8 mg) — VIEW 1+2 trials (Ophthalmology 2012) established non-inferiority to ranibizumab; Eylea HD extends dosing to 12–16-weekly
Faricimab (Vabysmo 6 mg) — bispecific anti-VEGF-A / anti-Ang-2; TENAYA + LUCERNE (Lancet 2022) showed non-inferiority to aflibercept with dosing intervals extending to 16 weekly; PBS-listed Australia 2023
Brolucizumab (Beovu 6 mg) — PBS-listed but with a post-market signal of retinal vasculitis (~3–5%); used selectively

Most patients transition to a treat-and-extend regimen after initial loading: the injection interval is extended by 2–4 weeks when the retina is dry on OCT, and shortened if fluid recurs. This reduces injection burden while maintaining visual outcomes.

Geographic atrophy — the first therapies to slow progression

Until 2023, no treatment existed for dry AMD with geographic atrophy. Two complement-pathway inhibitors have now gained regulatory approval:

Pegcetacoplan (SYFOVRE) — C3 inhibitor; OAKS + DERBY trials showed 17–22% slower lesion growth at 24 months versus sham; TGA approved 2024; PBS listing status — verify current eligibility criteria with specialist
Avacincaptad pegol (IZERVAY) — C5 inhibitor; 14–18% reduction in lesion growth; regulatory status evolving — verify at point of prescribing

Critical expectation management: Neither treatment restores lost vision. Both slow the rate of atrophy enlargement without improving visual acuity. The procedures also carry risk: increased conversion to neovascular AMD (~7–12% at 2 years versus ~3–4% with sham), intraocular inflammation, and rare ischaemic optic neuropathy (pegcetacoplan signal). Patients must understand this before committing to regular intravitreal injections with no subjective vision gain. For many people with geographic atrophy, the burden of ongoing injections for a lesion-growth slowing effect may not align with their values and preferences.

C. The GP’s daily lane — monitoring, lifestyle, and the Amsler grid

What GPs do for AMD patients

RANZCO and eTG are clear about the GP’s role alongside the ophthalmology team:

From age 50: recommend a comprehensive eye examination with an optometrist or ophthalmologist every 1–2 years for all adults without known AMD; annually if early or intermediate AMD is confirmed or strong risk factors are present (smoker, family history, hypertension, light irides).
Smoking cessation: the highest-yield AMD intervention. Brief intervention and pharmacotherapy at every visit. Varenicline, nicotine replacement therapy, and bupropion are PBS-funded. Quitline 13 7848. For people with AMD: “Quitting halves the chance this disease will get worse.”
Blood pressure and lipids: control to standard cardiovascular targets; both share vascular pathophysiology with AMD. See companion articles on hypertension and dyslipidaemia.
Mediterranean-pattern diet: green leafy vegetables (kale, spinach — high in lutein and zeaxanthin) daily; oily fish twice weekly (omega-3 DHA); olive oil, nuts, limited processed meat. MDFA dietary recommendations align.
AREDS2 prescription for intermediate AMD or advanced AMD in one eye — specify the AREDS2 formulation (not AREDS1 with beta-carotene) and document smoking status.
Amsler grid: provide to every patient with intermediate or advanced AMD; instruct on correct daily home monitoring technique. MDFA provides a printable Amsler grid.
Urgent referral for new metamorphopsia: same-day to same-week ophthalmology for new wavy lines or central distortion in a patient with known intermediate AMD — assume wet AMD until proven otherwise.
Coordinate around injection schedule: for patients on anti-VEGF therapy, assist with transport planning, medication reconciliation at each visit, and mental health screening.
Low-vision rehabilitation referral when corrected acuity falls below 6/12 in the better eye or when central scotoma is affecting daily activities.
Driving fitness review per Austroads visual standards; obtain an ophthalmology or optometry letter for the licensing authority when required.

D. Australian operations

MBS items

Standard consultations (MBS 23, 36, 44). 75+ Health Assessment (MBS 707) includes vision review — AMD is a core component. ATSI Health Assessment (MBS 715) includes eye examination; the Visiting Optometrists Scheme provides outreach to remote communities. GPCCMP (MBS 965/967) for AMD with comorbidities — includes optometry and OT referral in the care plan. GP Mental Health Treatment Plan (MBS 2715/2717) for depression burden associated with vision loss. Ophthalmology referral items: 104/105 initial/subsequent specialist consultation (referral required for Medicare rebate).

PBS for wet AMD

Anti-VEGF agents (ranibizumab including biosimilar, aflibercept including Eylea HD, faricimab, brolucizumab) are under the PBS Section 100 Highly Specialised Drugs Program, Authority Required, initiated by an ophthalmologist. Eligibility requires OCT confirmation of activity and visual acuity criteria. Bevacizumab (Avastin) is used off-label and unsubsidised in some public hospital services.

Low-vision services

Vision Australia — comprehensive low-vision assessment, magnification aids, assistive technology, orientation and mobility training, in-home OT, and peer support.

MDFA helpline 1800 111 709 — patient information, peer support, AMD national registry.

NDIS (under 65) and My Aged Care (65+) fund assistive devices, home modifications, and community support services for people with vision impairment from AMD. GP referral to an NDIS planner or My Aged Care assessment team triggers this pathway.

Vision 2020 Australia

Vision 2020 Australia is the national peak body for eye health; it coordinates AMD awareness campaigns and the ophthalmic service network.

E. Special populations

Older adults and frailty

Intravitreal injection burden (monthly to 16-weekly appointments) can become disproportionate in very frail, elderly patients. The GP plays an important role in advocating for the patient’s perspective in these discussions — weighing injection burden, transport requirements, and quality-of-life impacts against the degree of vision preservation achieved. Goals-of-care conversations are appropriate.

Aboriginal and Torres Strait Islander Australians

The major causes of vision impairment in ATSI communities are diabetic retinopathy, cataract, refractive error, and trachoma — rather than AMD, which has a relatively lower burden in ATSI populations. However, AMD still occurs and should be considered in older ATSI patients. Eye health services in remote and very-remote communities are delivered through the Visiting Optometrists Scheme and outreach ophthalmology. MBS 715 annual health assessments include vision screening.

Cataract surgery in AMD patients

A longstanding concern was that cataract surgery might accelerate AMD. Current evidence does not support this — cataract surgery is not a contraindication in AMD patients. Pre-operative counselling should note that cataract removal improves overall visual input but will not reverse AMD-related central vision loss; the improvement ceiling is determined by the degree of macular damage.

AMD significantly increases risk of depression, social withdrawal, and early entry to residential care. Routine PHQ-9 screening at AMD reviews is worthwhile. Referral to Vision Australia peer support and the MDFA helpline reduces isolation. Mental Health Care Plan access via MBS 2715/2717 enables psychology referral.

When to escalate

Same-day to same-week urgent ophthalmology referral:

New metamorphopsia or central visual distortion in a patient with known intermediate AMD — assume wet AMD
Sudden monocular vision change of any kind — rule out retinal detachment, central retinal artery or vein occlusion, vitreous haemorrhage, ischaemic optic neuropathy, or stroke
Post-injection pain, redness, or vision deterioration at 1–7 days post-injection — endophthalmitis until proven otherwise; same-day specialist

Eye pain or redness is NOT typical for AMD: acute angle-closure glaucoma, anterior uveitis, scleritis, or keratitis are alternative diagnoses requiring urgent assessment.

Routine ophthalmology referral:

Any patient with confirmed intermediate AMD who does not yet have ophthalmology follow-up
Vision falling below 6/12 in the better eye — low-vision rehabilitation
New diagnosis of any AMD stage — initiate the ophthalmology care relationship

What this article is and is not

This article is general health information drawn from current Australian ophthalmological guidelines — RANZCO AMD guidelines, Therapeutic Guidelines — Ophthalmology, MDFA, AAO PPP 2023 — and clinical trial data including AREDS2, VIEW 1+2, TENAYA+LUCERNE, and OAKS+DERBY. It is not personal medical advice and does not create a doctor–patient relationship. AMD management decisions — including eligibility for anti-VEGF, geographic atrophy treatment, and AREDS2 formulation — are made with your GP, optometrist, and treating ophthalmologist.

Australian consumer resources: MDFA, MDFA helpline 1800 111 709, Vision Australia, HealthDirect — AMD.

Sources cited

Frequently asked questions

What is the difference between dry and wet AMD?

Dry AMD (also called geographic atrophy in its advanced form) accounts for about 85–90% of all AMD. It progresses slowly over years as light-sensitive cells in the central retina gradually deteriorate, causing a slowly enlarging blind spot in the centre of vision. Wet (neovascular) AMD accounts for 10–15% of AMD but is responsible for a disproportionate share of severe vision loss because new, leaky blood vessels grow under the retina and can cause rapid central vision deterioration. The key early symptom of wet AMD is metamorphopsia — straight lines appear wavy. This requires same-day or same-week ophthalmology referral.
What are AREDS2 supplements and should I take them?

AREDS2 supplements are a specific combination proven in large clinical trials to slow AMD progression: vitamin C 500 mg, vitamin E 400 IU, lutein 10 mg, zeaxanthin 2 mg, zinc 25–80 mg, and copper 2 mg. They reduce the risk of progressing to advanced AMD by about 25% in people with intermediate AMD or advanced AMD in one eye. They are not recommended for early AMD or general eye health in people without AMD — evidence does not support benefit in these groups. AREDS2 supplements are not PBS-funded and cost roughly $30–60 per month. Smokers must use the AREDS2 formula only — the older AREDS1 formula contains beta-carotene, which increases lung cancer risk in current or recent smokers.
How are wet AMD injections given, and how often?

Intravitreal anti-VEGF injections are administered by an ophthalmologist directly into the vitreous cavity of the eye under local anaesthesia, typically in an outpatient procedure room. The eye is numbed with drops; the injection takes seconds and is usually well-tolerated, though pressure and a brief sting may be felt. After a loading phase (usually 3–4 monthly injections), most patients move to a treat-and-extend schedule where the interval between injections is adjusted based on retinal OCT findings — ranging from 4 to 16 weeks depending on the agent and individual response. Most people require ongoing injections long-term to maintain vision stability.
Can AMD cause total blindness?

AMD affects only the macula — the central 5% of the retina responsible for fine detail vision: reading, recognising faces, and colour perception. Even in advanced AMD, peripheral (side) vision is preserved. AMD does not cause complete blindness. However, the loss of central vision can be severe and profoundly affect independence — reading, driving, face recognition, and watching television. This is an important reassurance for patients newly diagnosed, but it does not diminish the real functional and psychological impact. Low-vision rehabilitation (Vision Australia, Macular Disease Foundation Australia) supports independent living and should be offered as soon as functional impact is present.
What should I do if I notice wavy lines when looking at a door frame or grid?

Metamorphopsia — straight lines appearing wavy, distorted, or missing — is the classic early warning sign of wet AMD. It most commonly develops in someone who already has intermediate dry AMD in one or both eyes. This symptom requires the same day or same week contact with an ophthalmologist or optometrist experienced in macular disease, not a routine GP appointment. Do not wait to see if it resolves. If you have intermediate AMD, check each eye separately on an Amsler grid (available from the Macular Disease Foundation Australia website) once or twice weekly. New distortion on the Amsler grid is the trigger for urgent review.

Source quality

Sources grouped by evidence tier. AU primary tier first; international where AU is silent or lagging; named-author reconstruction where guidelines have not yet caught up. How tiers work.

T1 AU primary 6 sources
T2 International primary 1 source
- AAO Preferred Practice Pattern — Age-Related Macular Degeneration 2023
T3 Named-author reconstruction 4 sources