Wet AMD vs dry AMD: treatment options explained for UK patients in 2026

Fast answer: dry vs wet AMD at a glance

Dry AMD is slow, wet AMD is fast. Both share the same risk factors but require very different management. The 2026 UK quick guide:

What is age-related macular degeneration?

The macula is the central 5 mm of the retina, packed with cone photoreceptors and responsible for sharp central vision, reading, fine detail, colour and face recognition. Age-related macular degeneration (AMD) is a progressive disease of the macular retinal pigment epithelium (RPE), Bruch’s membrane and choriocapillaris driven by ageing, oxidative stress and complement-mediated inflammation.

Lipoprotein and cellular debris accumulates as drusen beneath the RPE. Over years RPE function fails, photoreceptors atrophy and central vision gradually deteriorates — this is the dry pathway. In a subset of patients the choroid grows new, abnormal blood vessels through Bruch’s membrane (choroidal neovascularisation) which leak fluid and blood beneath or within the retina — this is the wet pathway and can cause rapid sight loss within weeks if untreated.

AMD never affects peripheral vision, so total blindness from AMD does not occur. The worst-case scenario is severe loss of central reading vision in both eyes.

Dry vs wet AMD: head-to-head comparison

Symptoms: when to suspect AMD — and when to act fast

Symptom timing is the single most useful clinical clue. Slow change favours dry AMD; sudden change favours wet AMD or another emergency.

Use a simple Amsler grid at home, one eye at a time, weekly, with reading glasses if you wear them. Any new distortion or missing area is a red flag and should be reported the same day.

How AMD is diagnosed in 2026

A consultant ophthalmologist (medical retina subspecialist) confirms AMD and its subtype with a focused history and a panel of standard imaging tests:

1. History & symptom timing — gradual vs sudden, monocular vs binocular.
2. Visual acuity — Snellen and ETDRS letter scores; reading speed.
3. Amsler grid — in clinic and at home for ongoing monitoring.
4. Slit-lamp biomicroscopy — dilated examination of the macula.
5. Optical coherence tomography (OCT) — the gold-standard test, identifies drusen, atrophy, intraretinal / subretinal fluid and pigment epithelial detachment (PED).
6. OCT angiography (OCTA) — visualises choroidal neovascularisation without dye injection.
7. Fundus autofluorescence — maps geographic atrophy and at-risk RPE areas.
8. Fluorescein angiography — reserved for atypical or polypoidal lesions.

In clinically suspected wet AMD the goal is to start anti-VEGF treatment at the same visit (one-stop service) or within 1 to 2 weeks — speed of treatment determines visual outcome.

Treatment options: dry vs wet AMD in 2026

Dry AMD

• AREDS2 supplements — vitamin C 500 mg, vitamin E 400 IU, lutein 10 mg, zeaxanthin 2 mg, zinc oxide 80 mg (or 25 mg low-zinc), cupric oxide 2 mg. Reduces 5-year risk of progression to advanced AMD by ~25% in eligible intermediate-stage patients. Not licensed for prevention.
• Strict smoking cessation — smoking is the single biggest modifiable risk factor and continued smoking accelerates progression to advanced AMD.
• Cardiovascular risk control — blood pressure, cholesterol, glucose, weight.
• Mediterranean-style diet — oily fish twice weekly, dark green leafy vegetables, nuts, olive oil; reduce ultra-processed foods.
• UV and blue-light protection — wraparound sunglasses on bright days.
• Amsler grid monitoring — weekly, each eye independently.
• Low-vision support — magnifiers, large-print, screen readers, certified visual impairment registration where appropriate.

Wet AMD — anti-VEGF injection therapy

Wet AMD is treated by intravitreal injection of an anti-VEGF agent that blocks the vascular endothelial growth factor signal driving abnormal blood vessel growth and leakage:

Standard regimens start with three monthly loading injections, then move to a treat-and-extend protocol where the interval between injections is extended in 2-week steps as long as the OCT macula remains dry. Most UK 2026 patients receive 6–8 injections in year 1 and 4–6 injections per year thereafter. Treatment is generally lifelong.

Geographic atrophy and the new complement inhibitors

Late-stage dry AMD with geographic atrophy (GA) — sharply demarcated patches of RPE and outer-retinal loss — was untreatable until recently. In 2023–2024 the FDA approved two intravitreal complement inhibitors that slow GA growth:

• Pegcetacoplan (Syfovre) — complement C3 inhibitor, monthly or every-other-month intravitreal injection.
• Avacincaptad pegol (Izervay) — complement C5 inhibitor, monthly intravitreal injection.

Both drugs slow but do not reverse GA growth, with reductions in lesion expansion of approximately 15–25% in pivotal trials. Risks include a small increased rate of conversion to wet AMD and intraocular inflammation. UK NICE evaluation is ongoing in 2026 and these agents are not yet routinely available on the NHS; selected private use is offered on a named-patient basis at major UK medical retina centres.

Lifestyle, supplements and self-monitoring — what works

For a fuller breakdown of how vision changes after cataract surgery and how to distinguish AMD from cataract, see why does my vision get cloudy years after cataract surgery?

UK 2026 AMD treatment cost: NHS vs private

For the private cataract pathway and how it interacts with macular disease, see can my optician refer me for private cataract surgery in the UK?

FAQs: wet vs dry AMD (UK 2026)

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