Ask most people what wet macular degeneration is and you get some version of worse. Dry is the mild one, wet is the bad one, and you hope to have the first.
That is roughly true about outcomes and almost entirely wrong about what is happening, which matters because the two conditions ask completely different things of you.
Why the label decides everything else
It is worth seeing the two side by side before any of the detail, because almost every practical question people ask resolves at this table.
| Dry AMD | Wet AMD | |
|---|---|---|
| What is physically happening | Drusen build up, macular tissue thins | New vessels grow under the retina and leak |
| How common | Most people with AMD have this form | The less common type |
| Stages | Early, intermediate, late | Always classed as late stage |
| How fast | Usually years | Can change vision over weeks or days |
| Main medical response | Monitoring, risk factors, and in one stage a supplement | Anti-VEGF injections, or photodynamic therapy |
| Where AREDS2 evidence applies | Intermediate stage only | Not a treatment for it |
| What you do at home | Check one eye at a time, most days | Attend appointments, and report changes immediately |
Descriptions of type, staging and treatment follow the National Eye Institute's own AMD pages. The AREDS row is the enrolment criteria of the two trials rather than anything a manufacturer claims.
Dry AMD, and its three stages
Dry AMD, also called atrophic AMD, is what most people have. It happens in three stages, and the stage is the fact that determines what anyone can usefully tell you.
Early
Small or medium drusen and, according to the National Eye Institute, no symptoms at all. This is a stage found by an examination rather than noticed by a person. It is also the stage where most supplement marketing lands and where the trials found nothing to measure.
Intermediate
Larger drusen. Some people notice mild blurriness in central vision or trouble seeing in low light, and many notice nothing. This is the group both AREDS trials enrolled, and the only stage where the supplement numbers have anything behind them. We wrote out who those numbers actually cover.
Late
Tissue at the macula has been lost, and there is a blurry or missing area near the centre of vision. Straight lines can start to look wavy. Where the loss forms distinct patches of atrophy, it is often called geographic atrophy, a term that appears in the AREDS trial criteria as well as in clinic letters.
The important thing about the three stages is that they are not a schedule. Plenty of people sit at early or intermediate for the rest of their lives.
Wet AMD, and why it is a different kind of problem
Wet AMD, or advanced neovascular AMD, is not simply dry AMD that has got worse. Something new has started.
Abnormal blood vessels grow beneath the retina. They are fragile, they leak fluid and blood into tissue that has no room for either, and the macula distorts and scars. That is why the classic symptom is not fading but bending: straight lines look wavy, because the surface they are being imaged onto is no longer flat.
This is also why it is urgent in a way that dry AMD is not. Vessels grow on their own timetable. The National Eye Institute lists two treatment routes: anti-VEGF medicines injected into the eye, and photodynamic therapy, which combines injections with laser.
Can dry AMD turn into wet AMD?
Yes, and the National Eye Institute puts it about as directly as it can be put:
Any stage of dry AMD can turn into wet AMD, but wet AMD is always late stage.
Read that carefully, because two things are packed into it. The first is that early dry AMD does not have to pass through intermediate and late before it can become wet. The second is that if it becomes wet, it has by definition become late-stage disease, whatever your last letter said.
That combination is the entire argument for checking your vision at home. Not because looking at a grid does anything for your retina, but because the interval between your appointments is measured in months and this transition is not.
What you are actually looking for
The American Academy of Ophthalmology's instructions for an Amsler grid are specific: hold it 12 to 15 inches from your face in good light, cover one eye, focus on the centre dot, and see whether the surrounding lines stay straight. Then swap eyes. Once a day.
- Lines that look wavy, bent or crooked where they used to be straight.
- An area that looks darker, blank or blurry.
- Anything that has changed since yesterday, in either eye separately.
The AAO's guidance on finding any of those is to contact your ophthalmologist right away. Covering one eye is not optional, incidentally: with both open, the better eye fills in the gap and you will not see what is missing.
Where supplements sit, and where they do not
This is the question that brings most people to the difference in the first place, so it deserves a straight answer.
The AREDS trials enrolled people with intermediate AMD, or advanced AMD in one eye. In that group, five-year progression to advanced AMD was 28% on placebo and 20% on the formulation. That is the whole basis of the category, and we take the number apart in detail elsewhere.
What the trials do and do not support
Supported
- Intermediate dry AMD, or advanced AMD in one eye
- Slowing progression to advanced disease, by about eight percentage points over five years
- The formulation as a package, at the tested amounts
Not supported
- Treating wet AMD, which no trial tested it for
- Early dry AMD, where five-year progression risk was 1.3%
- Replacing or delaying anti-VEGF treatment in anybody
People with wet AMD in one eye are sometimes advised on a formulation because of the fellow eye, which is a real and specific clinical reason. That decision belongs to your ophthalmologist, who knows what both of your eyes look like. It is not something to work out from an article.
So which one is worse?
Wet AMD threatens central vision faster. Late dry AMD, once atrophy is established at the centre, causes loss that nothing currently reverses. Neither is the good news, and comparing them is less useful than it feels.
The more useful framing is that they fail differently, so they are caught differently. Wet AMD announces itself, which is why the grid works. Dry AMD does not, which is why the appointments matter even when nothing feels wrong.
And neither form typically takes all of your sight. AMD damages the macula, which is central vision. Peripheral vision comes from the rest of the retina and is not the target. That is a real distinction and worth holding on to, and it is not the same as saying the condition is minor.
If you have just been given one of these two words and are not sure what to do with it, we wrote the order the decisions actually come in.