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# Macular degeneration and retinitis pigmentosa

- Lesion

Macular degeneration destroys central vision in older adults; retinitis pigmentosa is an inherited loss of rods that starts with night blindness.

Updated Nov 12, 2026

## Key points

- Drusen: extracellular deposits of lipids, proteins and complement under the pigment epithelium.
- Dry AMD: geographic atrophy of pigment epithelium and photoreceptors; slow loss of central vision.
- Wet AMD: choroidal neovascular membrane, subretinal fluid and hemorrhage, disciform scar; fast loss of vision; treated with anti-VEGF.
- Risk: age, smoking, family history, CFH and ARMS2/HTRA1 variants; antioxidant supplements slow some intermediate cases.
- Retinitis pigmentosa: rod-cone degeneration, night blindness, tunnel vision; bone-spicule pigment, waxy disc, thin vessels; many genes (RHO most common dominant).

## What it is

Age-related macular degeneration (AMD) is the commonest cause of irreversible central visual loss in older adults in high-income countries. Deposits called drusen collect between the retinal pigment epithelium and Bruch membrane. In dry (atrophic) AMD, the pigment epithelium and photoreceptors are slowly lost; in wet (neovascular) AMD, choroidal vessels grow through Bruch membrane, leak and bleed, then scar. Risk factors include age, smoking and variants in complement genes such as CFH. Retinitis pigmentosa is a group of inherited diseases of rods and then cones.

## Step by step

- With age, waste from photoreceptor renewal builds up under the pigment epithelium.
- Drusen form and activate complement; inherited CFH variants weaken its control.
- Inflammation and oxidative stress damage pigment epithelium and Bruch membrane.
- Pigment epithelium and photoreceptors die (dry AMD), or
- Choroidal vessels break through Bruch membrane, leak and bleed under the macula (wet AMD).
- Bleeding organises into a disciform scar and central vision is lost.

## Dry vs wet AMD and retinitis pigmentosa

| Feature | Dry AMD | Wet AMD | Retinitis pigmentosa |
| --- | --- | --- | --- |
| Main lesion | Drusen, pigment epithelium atrophy | Choroidal new vessels through Bruch membrane | Rod then cone loss |
| [Speed](https://durgical.com/en/conditions/age-related-macular-degeneration/) | Slow, years | Weeks to months | Years, from childhood or youth |
| Vision lost | Central | Central, with distortion | Peripheral and night vision first |
| [Fundus](https://durgical.com/en/conditions/retinitis-pigmentosa/) | Yellow drusen, geographic atrophy | Fluid, blood, grey membrane, scar | Bone-spicule pigment, pale disc, thin vessels |
| Treatment | Supplements in selected cases | Anti-VEGF injections | Supportive; gene therapy for some forms |

## Clinical notes

- Distortion of straight lines (metamorphopsia) on an Amsler grid suggests wet AMD and needs urgent referral.
- People with AMD keep peripheral vision and benefit from low-vision rehabilitation.

## Memory aid

Dry AMD fades the centre slowly; wet AMD floods it fast with new vessels; RP starts in the dark and closes the tunnel.

## Test yourself

Think of the answer, then tap the question to see it.

## What are drusen?

Extracellular deposits of lipid, protein and complement between the retinal pigment epithelium and Bruch membrane.

## What defines wet (neovascular) AMD?

Choroidal new vessels that grow through Bruch membrane under the retina, leaking fluid and blood.

## Which cells are lost first in retinitis pigmentosa?

Rod photoreceptors, causing night blindness and loss of peripheral vision, followed by cones.

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## Elsewhere in DurgiPedia

- [The retina and macula as seen on OCT](https://durgical.com/en/ophthalmology/the-retina-and-macula-as-seen-on-oct/)
- [Intravitreal anti-VEGF injections](https://durgical.com/en/ophthalmology/intravitreal-anti-vegf-injections/)
- [Gradual visual loss in adults](https://durgical.com/en/ophthalmology/gradual-visual-loss-in-adults/)
- [Retina: the ten layers, rods and cones](https://durgical.com/en/histology/retina-the-ten-layers-rods-and-cones/)
- [The retina and phototransduction](https://durgical.com/en/physiology/the-retina-and-phototransduction/)
- [Complement: three pathways, MAC, regulators](https://durgical.com/en/immunology/complement-three-pathways-mac-regulators/)

## Connections

## Related 5

- [Diabetic and hypertensive retinopathy](https://durgical.com/en/general-pathology/diabetic-and-hypertensive-retinopathy/)
- [Retinal detachment](https://durgical.com/en/general-pathology/retinal-detachment/)
- [Cellular aging: telomeres, DNA damage, senescence and proteostasis](https://durgical.com/en/general-pathology/cellular-aging-telomeres-dna-damage-senescence-and-proteostasis/)
- [Tumour angiogenesis](https://durgical.com/en/general-pathology/tumour-angiogenesis/)
- [Tobacco: how smoking injures tissue](https://durgical.com/en/general-pathology/tobacco-how-smoking-injures-tissue/)

## Related conditions 2

- [Age-related macular degeneration](https://durgical.com/en/conditions/age-related-macular-degeneration/)
- [Retinitis pigmentosa](https://durgical.com/en/conditions/retinitis-pigmentosa/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Macular Degeneration | Age-related Macular Degeneration | MedlinePlus](https://medlineplus.gov/maculardegeneration.html) (MedlinePlus, US National Library of Medicine, 2026).

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Source: https://durgical.com/en/general-pathology/macular-degeneration-and-retinitis-pigmentosa/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/macular-degeneration-and-retinitis-pigmentosa/