What are the key clinical features to differentiate between dry and wet age-related macular degeneration (AMD) during assessment?

Key clinical features differentiating dry and wet age-related macular degeneration (AMD) during assessment include:

• Dry AMD (Late AMD - dry): Characterised by geographic atrophy without neovascularisation, presence of drusen (especially large drusen ≥125 micrometres), pigmentary changes, and atrophy affecting the retinal pigment epithelium (RPE). Visual loss tends to be gradual and progressive. Slit-lamp biomicroscopy shows drusen and atrophic changes without retinal thickening or elevation. Visual acuity is often significantly reduced (6/18 or worse) in advanced cases ³.
• Wet AMD (Late AMD - wet active): Characterised by neovascularisation such as classic or occult choroidal neovascularisation (CNV), retinal angiomatous proliferation, or polypoidal choroidal vasculopathy. Clinical features include rapid onset visual loss, visual distortion (metamorphopsia), and retinal thickening or elevation due to fluid or haemorrhage. Slit-lamp biomicroscopy may reveal exudative or haemorrhagic changes. Optical coherence tomography (OCT) shows subretinal or intraretinal fluid, and fluorescein angiography confirms abnormal vascular leakage ¹,²,³.

Urgent referral is indicated for suspected wet AMD due to its rapid progression and potential for severe vision loss, whereas dry AMD progresses more slowly and is monitored differently ¹,².