Snapshot A 65-year-old male presents with progressive left-eye central vision loss over the last few months. His peripheral vision is intact. The patient denies smoking and drinks a 2-3 alcoholic beverages during social gatherings. When looking at a specific region in a line grid, he reports a dark “spot” in the center, with bent lines. Dilated ophthalmic examination is shown. Introduction Degenerative disease involving the macula → loss of central vision peripheral and navigational vision is uninvolved Classification wet (neovascular, exudative) pathogenesis involves choroidal neovascularization secondary to vascular endothelial growth factor (VEGF) disease progression usually occurs over months dry (atrophic) pathogenesis unclear drusen deposition (early in disease), retinal atrophy, central retinal degeneration disease progression usually occurs over decades Epidemiology mostly affects those > 50 years old a leading cause of blindness Presentation Symptoms wet-ARMD acute visual distortion central vision loss secondary to fluid accumulation usually affects one eye metamorphopsia can appear early in disease dry-ARMD gradual vision loss metamorphopsia Evaluation Clinical diagnosis retinal examination wet-ARMD hemorrhage or fluid in subretina neovascularization macular grayish-green discoloration dry-AMD drusen deposition areas of retinal atrophy (depigmentation) retinal pigment epithelium motteling (pigmentation) Fluorescein retinal angiography Optical coherence tomography (OCT) Amsler grid line distortion seen on grid Differential Vascular tumors of the retina e.g., von Hippel-Lindau disease Treatment wet-ARMD VEGF inhibitors (e.g., bevacizuzmab) photodynamic therapy zinc and antioxidant vitamins dry-ARMD zinc and antioxidant vitamins Prognosis, Prevention, and Complications Prevention certain vitamin supplements and dietary factors may reduce the risk of ARMD Complications blindness