Age-related macular degeneration (MD) is a progressive eye disease that impairs central vision by damaging the macula, the part of the retina responsible for sharp, detailed sight. This condition is a leading cause of vision loss among older adults and requires a coordinated approach from various eye care professionals. Understanding which doctors are involved is the first step in managing this diagnosis. The necessary level of medical expertise changes depending on whether the disease is in its early, “dry” form or its advanced, “wet” form.
Initial Detection and Referral
The journey of a patient with macular degeneration often begins with their primary eye care provider, typically an Optometrist. An Optometrist (O.D.) conducts routine eye examinations, prescribes corrective lenses, and detects signs of eye diseases. During a comprehensive dilated eye exam, they look for signs of early MD, such as drusen, small yellow deposits beneath the retina.
If an Optometrist identifies these early changes, they may refer the patient to a medical eye doctor, an Ophthalmologist. An Ophthalmologist (M.D. or D.O.) specializes in eye and vision care, licensed to practice medicine and surgery. This physician confirms the diagnosis of dry MD and manages non-interventional stages, often recommending nutritional supplements like the AREDS 2 formula to slow progression.
The primary function of both the Optometrist and the general Ophthalmologist is early detection and continuous surveillance. If the disease progresses to the more aggressive “wet” form, which involves the growth of abnormal, leaking blood vessels, an immediate referral to a sub-specialist is necessary. The general Ophthalmologist typically does not perform the complex treatments required for active wet MD.
The Definitive Treating Specialist
The specific doctor who treats advanced, wet macular degeneration is the Vitreoretinal Specialist, often referred to as a Retinal Specialist. This physician is an Ophthalmologist who has completed an additional one-to-two-year fellowship focused exclusively on diseases and surgery of the retina and the vitreous. This sub-specialization is necessary because the retina is delicate, and the interventions required for wet MD are complex.
Vitreoretinal Specialists manage sight-threatening retinal conditions requiring sophisticated medical and surgical intervention. They are the authority for diagnosis and treatment of the active disease, practicing in specialized clinics or hospital settings equipped with high-level diagnostic technology. Their training allows them to interpret advanced imaging and determine the precise moment intervention is needed to prevent rapid, permanent vision loss.
This specialist becomes the patient’s long-term physician for all active treatment phases of macular degeneration. They manage conditions like choroidal neovascularization, the growth of abnormal blood vessels that characterizes wet MD. The Retinal Specialist’s focused expertise distinguishes them from general Ophthalmologists, who address a broader range of eye conditions like cataracts or glaucoma.
Ongoing Management and Treatment
The Retinal Specialist uses advanced diagnostic tools to monitor disease activity and guide treatment decisions. Optical Coherence Tomography (OCT) is a non-invasive imaging test that provides detailed cross-sectional images of the retina, allowing the specialist to precisely measure fluid buildup beneath or within the macula. Fluorescein Angiography, which involves injecting a fluorescent dye into the bloodstream, is also used to identify the location and extent of leaking blood vessels.
The primary treatment for wet MD is the use of anti-VEGF agents, medications injected directly into the vitreous of the eye—an intravitreal injection. These drugs work by blocking Vascular Endothelial Growth Factor (VEGF), a protein that stimulates the growth and leakage of the abnormal blood vessels. Commonly used agents include ranibizumab, aflibercept, and bevacizumab, and the injections are given in a sterile clinical environment.
Treatment typically follows a “treat-and-extend” protocol, where the interval between injections is gradually lengthened as long as the retina remains stable, guided by OCT findings. Patients may require an average of six to fourteen injections per year to maintain visual stability and prevent further vision loss. Following the active treatment phase, a low-vision specialist may assist the patient with rehabilitation by providing specialized tools and strategies to maximize their remaining vision.