Macular Degeneration
Surgery types, recovery, NHS vs private options, and FAQs
Overview
Age-related macular degeneration (AMD) is a progressive eye condition that affects the macula, the small central area of the retina responsible for sharp, detailed vision used for reading, driving, and recognising faces. AMD is the leading cause of severe sight loss in the UK, affecting over 600,000 people, with the number expected to rise significantly as the population ages.
There are two main forms of AMD. Dry AMD (also called atrophic AMD) accounts for approximately 90% of cases and involves a gradual thinning and deterioration of the macular cells. It progresses slowly over years and currently has limited treatment options, though new therapies are emerging. Wet AMD (neovascular AMD) accounts for around 10% of cases but is responsible for the majority of severe vision loss from the condition. It occurs when abnormal blood vessels grow beneath the retina, leaking fluid and blood that damage the macula.
While AMD does not cause total blindness — peripheral vision is preserved — the loss of central vision can have a profound impact on independence and quality of life. Early detection through regular eye tests, prompt treatment of wet AMD with anti-VEGF injections, and lifestyle modifications can all help to preserve vision for longer.
Symptoms
- Blurred or distorted central vision (straight lines may appear wavy or bent)
- A dark or empty area in the centre of your vision
- Difficulty reading, even with reading glasses
- Colours appearing less vivid or harder to distinguish
- Difficulty recognising faces
- Needing brighter light for close-up tasks
- Slow recovery of visual function after exposure to bright light
- In wet AMD: rapid onset of visual distortion or sudden worsening of central vision
When Surgery is Needed
Treatment for macular degeneration depends on the type and stage of the disease. Strictly speaking, AMD is treated with injections rather than conventional surgery, though the procedure is performed in a clinical or operating theatre setting.
Wet AMD requires urgent treatment with anti-VEGF (anti-vascular endothelial growth factor) injections. Treatment should ideally begin within two weeks of diagnosis to prevent irreversible damage. You should seek treatment urgently if you notice:
- Sudden distortion of your vision (straight lines appearing wavy)
- A rapid deterioration in your central vision
- A new dark spot or blank area in the centre of your vision
For dry AMD, there is currently no widely available surgical treatment on the NHS, though clinical trials are ongoing. New complement inhibitor therapies (such as pegcetacoplan) have recently been approved in some countries and may become available in the UK. Photobiomodulation (PBM) therapy is offered by some private providers for early to intermediate dry AMD.
Types of Surgery
Anti-VEGF intravitreal injections
The standard treatment for wet AMD. Medications such as ranibizumab (Lucentis), aflibercept (Eylea), faricimab (Vabysmo), or bevacizumab (Avastin) are injected directly into the vitreous cavity of the eye to block the growth factor that drives abnormal blood vessel formation. Treatment typically begins with a loading phase of monthly injections for 3 months, followed by ongoing injections at intervals determined by your response. The injection takes seconds and is performed under local anaesthetic drops.
Photobiomodulation (PBM) therapy
A non-invasive light-based therapy for early to intermediate dry AMD. Low-level light energy is delivered to the retina via a comfortable eye mask device. Clinical studies have shown improvements in visual function and retinal structure. PBM is currently available only as a private treatment in the UK and typically involves a course of 9 sessions.
Photodynamic therapy (PDT)
A light-activated treatment occasionally used for certain subtypes of wet AMD. A photosensitive drug (verteporfin) is injected intravenously and then activated by a non-thermal laser applied to the retina. PDT is less commonly used since the widespread adoption of anti-VEGF therapy but remains an option for specific cases.
Vitrectomy surgery (rare cases)
In rare and severe cases of wet AMD with significant submacular haemorrhage (bleeding beneath the macula), vitrectomy surgery may be performed to remove blood and deliver medication directly beneath the retina. This is typically reserved for emergency situations and is not a routine AMD treatment.
Recovery
Recovery from anti-VEGF injections is minimal. The procedure itself takes only a few minutes, and most patients can return home shortly afterwards. You may experience mild discomfort, redness, or a gritty sensation in the eye for a day or two. Your vision may be slightly blurry immediately after the injection due to the anaesthetic drops and the injection itself, but this typically clears within a few hours.
You will be advised to avoid rubbing your eye and to use antibiotic eye drops for a few days after each injection. Serious complications, such as infection (endophthalmitis), are very rare, occurring in fewer than 1 in 1,000 injections.
It is important to understand that anti-VEGF treatment is ongoing. Most patients require injections at regular intervals — initially monthly, then potentially less frequently — for months or years. The goal is to stabilise or improve your vision, and regular monitoring with OCT scans is essential to determine when further injections are needed.
For PBM therapy, there is no recovery time. Sessions last approximately 35 minutes, and you can resume normal activities immediately afterwards.
NHS vs Private
Wet AMD treatment with anti-VEGF injections is available free on the NHS and is provided as an urgent service. Once diagnosed, treatment should begin within two weeks. The NHS uses NICE-approved anti-VEGF medications, and treatment is typically delivered in hospital eye services or specialist community clinics.
For dry AMD, the NHS currently offers monitoring, lifestyle advice, and referral to low-vision services, but there is no NICE-approved medical treatment. Private providers may offer photobiomodulation therapy (from approximately £1,495 to £1,645 per treatment cycle) and access to emerging therapies.
Private treatment for wet AMD is also available and may offer shorter waiting times for initial assessment, choice of anti-VEGF medication, and more flexible appointment scheduling. Private injection costs typically range from £800 to £1,200 per injection.
Regardless of which pathway you choose, early detection through regular eye tests and self-monitoring with an Amsler grid are essential for the best possible visual outcome.
Frequently Asked Questions
What is the difference between dry and wet AMD?
Are anti-VEGF injections painful?
How many injections will I need for wet AMD?
Can I prevent macular degeneration?
Will I go blind from macular degeneration?
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