Wet AMD vs Dry AMD: Treatment Options Explained UK 2026

Dry AMD is slow; wet AMD is fast. Both forms share the same risk factors but need very different management. Any new distortion of straight lines or sudden central blur in someone over 50 is a wet AMD red flag — it needs same-week ophthalmology assessment, not a routine optician appointment in six months.

Fast answer: dry vs wet AMD at a glance

Dry AMD is drusen and atrophy, with slow loss of central vision over years, managed with AREDS2 supplements, lifestyle change and Amsler grid monitoring. Wet AMD is abnormal new blood vessels and leakage, causing distortion and central blur over weeks, treated with anti-VEGF injections every 4 to 16 weeks for life. Around 10 to 15% of dry AMD eyes convert to wet AMD over 5 to 10 years.

Honest one-liner: any new distortion of straight lines or sudden central blur in someone over 50 is a wet AMD red flag — it needs same-week assessment, not a routine optician appointment in six months.

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 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

Feature	Dry AMD	Wet AMD
Proportion of cases	~85%	~15%
Pathology	Drusen, RPE atrophy, photoreceptor loss	Choroidal neovascularisation, leakage, haemorrhage
Speed of vision loss	Years	Days to weeks if untreated
Hallmark symptom	Gradual central blur	Sudden distortion of straight lines
OCT finding	Drusen, RPE atrophy, geographic atrophy in late disease	Subretinal / intraretinal fluid, PED, choroidal neovascularisation
Treatment	AREDS2 + lifestyle; complement inhibitors for GA (US)	Anti-VEGF intravitreal injections
Frequency of visits	Annual	Every 4–16 weeks
Risk of conversion	10–15% dry → wet over 5–10 years	N/A

Both can coexist: a single eye can have dry AMD with superimposed wet AMD, and the two eyes can be at different stages. Each eye is assessed individually.

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.

Dry AMD — gradual: slow blur of central reading vision over years, need for stronger reading lights, difficulty recognising faces from a distance, reduced contrast and colour vibrancy, and a central area appearing slightly faded or smudged.

Wet AMD — sudden / rapid: sudden distortion of straight lines (door frames, lined paper), a central grey or blurred patch (scotoma), words missing in the middle of a sentence, a rapid drop in reading vision over days to weeks, and object size appearing different in the two eyes.

Red flags for same-week ophthalmology referral: any new distortion of straight lines, central scotoma, sudden blur, words missing on the page, or any acute change in vision in someone over 50. 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 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:

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

New distortion or sudden central blur? A same-week consultant macula assessment includes OCT and a definitive diagnosis the same day.

Book an AMD assessment

Treatment options: dry vs wet AMD in 2026

Dry AMD is managed without injections in most cases:

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 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:

Drug	Brand(s)	UK status 2026	Typical maintenance interval
Aflibercept 2 mg	Eylea	NHS & private (NICE TA294)	8–12 weeks
Aflibercept 8 mg	Eylea HD	NHS & private (NICE TA924)	12–16 weeks
Ranibizumab 0.5 mg	Lucentis (and biosimilars)	NHS & private	4–8 weeks
Faricimab 6 mg	Vabysmo	NHS & private (NICE TA800)	12–16 weeks
Brolucizumab 6 mg	Beovu	Private (selected NHS use)	8–12 weeks

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 to 8 injections in year 1 and 4 to 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 to 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 to 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. Early dry AMD does not currently require any injection therapy — complement inhibitors are reserved for selected patients with documented expanding geographic atrophy threatening the central fovea.

Lifestyle, supplements and self-monitoring — what works

Strong evidence: AREDS2 supplements (intermediate AMD), strict smoking cessation, a Mediterranean-style diet, oily fish twice weekly (omega-3), dark green leafy vegetables and blood pressure control.

Probable benefit: daily exercise (30 minutes), weight reduction if BMI over 30, cholesterol management, diabetes control and wraparound UV-blocking sunglasses outdoors.

Not recommended: beta-carotene supplements in current or former smokers (lung cancer risk), high-dose unspecified multivitamins as a substitute for AREDS2, unregulated “eye health” supplements without published trial evidence, and blue-light blocking glasses for indoor screen use (no proven AMD benefit).

For 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

Pathway	Cost	Typical wait	Notes
NHS wet AMD pathway	Free at point of care	Same week (urgent)	Macula clinic; choice of drug per local formulary
Private wet AMD injection	£650–£1,250 per injection	Same week	Choice of drug; OCT included
Private medical insurance	Usually covered subject to excess	Same week	Pre-authorisation required; lifetime cap on some policies
AREDS2 supplements	£15–£30 per month	Over-the-counter	Look for the verified AREDS2 formulation

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)

What is the difference between wet and dry AMD?

Both wet (neovascular) and dry (non-neovascular) age-related macular degeneration affect the macula, the central area of the retina. Dry AMD is characterised by drusen deposits and atrophy of retinal pigment epithelium and photoreceptors; it accounts for around 85% of cases and progresses slowly over years. Wet AMD is characterised by abnormal new blood vessels (choroidal neovascularisation) leaking fluid and blood beneath the retina; it accounts for around 15% of cases and can cause rapid central vision loss within weeks if untreated. Around 10 to 15% of dry AMD cases convert to wet AMD over time.

What are the symptoms of wet AMD?

Wet AMD typically presents with sudden or rapidly worsening distortion of straight lines (metamorphopsia), a central blur or grey patch (scotoma) and reduced central reading vision in one or both eyes. Symptoms can develop over days to weeks. Any new distortion of straight lines (door frames, window panes, lined paper) in someone over 50 is a red flag and warrants same-week ophthalmology assessment.

What are the symptoms of dry AMD?

Dry AMD typically causes a gradual, painless reduction in central vision and contrast sensitivity over years. Reading and recognising faces become harder. Some patients describe a need for stronger reading lights or a faded central area. Late dry AMD with geographic atrophy can cause profound central vision loss but never affects peripheral vision; total blindness from AMD does not occur.

How is wet AMD treated in the UK in 2026?

Wet AMD is treated by intravitreal injections of anti-VEGF drugs that block the chemical signal driving abnormal blood vessel growth. UK 2026 first-line agents are ranibizumab (Lucentis and biosimilars), aflibercept 2 mg and 8 mg (Eylea), faricimab (Vabysmo) and brolucizumab (Beovu). Treatment is started with three monthly loading injections followed by a treat-and-extend regimen tailored by OCT response. NHS treatment is provided in dedicated medical retina services; private treatment is also available.

How is dry AMD treated in the UK in 2026?

Early and intermediate dry AMD is managed with the AREDS2 vitamin and mineral formula (vitamin C, vitamin E, lutein, zeaxanthin, zinc and copper), strict smoking cessation, blood pressure control, a Mediterranean-style diet rich in oily fish and dark green leafy vegetables, UV protection and home monitoring with an Amsler grid. From late 2024 the FDA-approved complement inhibitors pegcetacoplan and avacincaptad pegol have been used in the US for geographic atrophy; UK NICE evaluation is ongoing in 2026 and these agents are not yet routinely available on the NHS.

How often do wet AMD injections need to be given?

After three monthly loading injections, modern treat-and-extend regimens with aflibercept 8 mg, faricimab and ranibizumab biosimilars usually allow injection intervals to be extended to 8, 12 or 16 weeks based on OCT response. Most patients require 6 to 8 injections in the first year and 4 to 6 injections per year thereafter. Treatment is generally lifelong, although some patients reach a stable phase with minimal injection need.

Is dry AMD likely to turn into wet AMD?

Around 10 to 15% of intermediate dry AMD eyes convert to wet AMD over 5 to 10 years. The risk is higher in eyes with large drusen, pigmentary changes and reticular pseudodrusen. Patients with intermediate or advanced dry AMD should monitor each eye separately with an Amsler grid weekly and report any new distortion immediately. Early detection of wet conversion preserves vision; late detection often does not.

Are anti-VEGF injections painful?

No. Anti-VEGF injections are essentially painless when performed by an experienced injector. Numbing drops or a brief subconjunctival anaesthetic injection are used; an eyelid speculum keeps the eye open; the drug is delivered via a fine 30-gauge needle through the white of the eye. Patients describe a brief pressure sensation only. Mild redness or a small subconjunctival haemorrhage at the injection site for a few days is normal.

How much do private wet AMD injections cost in the UK in 2026?

UK 2026 private intravitreal injection fees typically range from £650 to £1,250 per injection, depending on the drug, location and whether OCT is included. Aflibercept 8 mg and faricimab are at the higher end; ranibizumab biosimilars are at the lower end. Most major UK private medical insurers cover wet AMD treatment subject to excess. NHS treatment is free at point of care.

Will I go blind from AMD?

AMD never causes total blindness because it spares peripheral vision. The worst-case scenario is severe central vision loss in both eyes, which can be registered as severely sight impaired and significantly affects reading and driving. With early detection, AREDS2 supplements for intermediate dry AMD and prompt anti-VEGF treatment for wet AMD, the great majority of UK patients in 2026 retain functional reading vision.

Sources and methodology

Clinical guidance: NICE TA294 (aflibercept), TA800 (faricimab), TA924 (aflibercept 8 mg), TA446 (ranibizumab biosimilars); Royal College of Ophthalmologists clinical guidelines for AMD.
Trial evidence: AREDS2 trial; VIEW, HAWK, HARRIER, TENAYA, LUCERNE and PULSAR pivotal trials; OAKS / DERBY (pegcetacoplan); GATHER1 / GATHER2 (avacincaptad pegol).
UK service data: RCOphth medical retina service standards; UK macula service activity data 2024–2026.
Editorial review: reviewed by a UK GMC-registered consultant medical retina specialist before publication.

Independent sources we reference: NICE TA294, NICE TA800, Royal College of Ophthalmologists, Macular Society and NHS overview of AMD.

Editorial information · not a substitute for personalised medical advice. Treatment suitability is confirmed by a UK GMC-registered consultant ophthalmologist at consultation.

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