Abigail ClarkeDame Judi Dench, 91, is gracing the cover of Yours magazine's landmark 500th issue this spring — but the interview accompanying it has caught attention for a different reason. The celebrated actress has spoken candidly, once again, about the severity of her vision loss. "I can't recognise anybody anymore," she said. "I can't see the television, I can't see to read." She now requires a companion at all times when she leaves home.
Dench was diagnosed with wet age-related macular degeneration (AMD) in 2012. Fourteen years on, her condition illustrates what happens when AMD progresses — and why early detection and specialist referral matter more than most people realise.
What is wet AMD and why is it different from "dry" AMD?
Age-related macular degeneration affects the macula — the central part of the retina responsible for sharp, detailed vision. It comes in two forms:
Dry AMD (the more common type) develops gradually as the macula thins over time. It progresses slowly over years and causes gradual central vision loss.
Wet AMD (the more severe form, which Dench has) occurs when abnormal blood vessels grow beneath the retina and leak fluid or blood. This can cause rapid, severe central vision loss — sometimes within days or weeks if untreated.
Around 700,000 people in the UK are living with AMD, according to the Macular Society. Wet AMD accounts for roughly 10% of all cases but is responsible for the majority of severe vision loss. It is the leading cause of sight loss in adults over 50 in the UK.
The symptoms to watch for — and why people miss them
AMD is notoriously easy to miss in the early stages. The brain compensates for changes in central vision, and people often only notice something is wrong when the condition is already well-established.
Key symptoms that warrant urgent assessment:
- Distorted vision — straight lines appear wavy or bent (known as metamorphopsia)
- A blurred or blank spot in the centre of your visual field
- Colours appearing less vivid or washed out
- Difficulty recognising faces even at close range
- Needing more light to read or complete detailed tasks
The Amsler Grid test — a simple grid of horizontal and vertical lines — is used by optometrists to detect distortion in central vision. It can be performed at home as an early screening tool. Anyone noticing changes should seek assessment immediately rather than waiting for their next routine eye check.
What happens at diagnosis: the NHS pathway
If wet AMD is suspected by an optometrist, the current NHS guidance calls for urgent referral to a hospital eye service — typically within one to two weeks. Speed matters enormously: wet AMD can cause significant irreversible damage within days.
At the hospital, a consultant ophthalmologist will perform:
- Optical Coherence Tomography (OCT) — a detailed scan of the retinal layers
- Fluorescein or OCT Angiography — to map abnormal blood vessel activity
If wet AMD is confirmed, treatment begins quickly.
Treatment: anti-VEGF injections
The current first-line treatment for wet AMD is anti-VEGF (anti-vascular endothelial growth factor) injection therapy. Drugs like Eylea (aflibercept), Lucentis (ranibizumab), and the newer Vabysmo (faricimab) are injected directly into the eye — typically every four to twelve weeks.
These injections do not reverse damage already done, but they can halt or slow further progression and, in many cases, partially restore some lost vision. Early treatment produces significantly better outcomes than delayed treatment.
Vabysmo, approved by NICE in 2023, offers a longer treatment interval — up to every four months in responding patients — reducing the burden of repeated hospital visits.
The injections are performed as an outpatient procedure under local anaesthetic. Most patients describe mild discomfort. The procedure takes around 15 minutes.
When to see a specialist and what to ask
If you are over 50 and have not had an eye examination in the past two years, booking one is a straightforward first step. Routine NHS eye tests at a registered optometrist are free for people over 60 and for those with certain conditions or risk factors.
You are at higher risk of AMD if you:
- Are over 60
- Have a family history of AMD
- Smoke or have smoked
- Have cardiovascular disease or high blood pressure
- Are of Northern European ethnic background
If you or a family member are experiencing any of the symptoms described above, do not wait for a routine appointment — contact your optometrist the same day or ask your GP for an urgent hospital eye service referral.
A consultant ophthalmologist can assess the stage of the condition, advise on the appropriate treatment pathway, and discuss both NHS and private options depending on your circumstances. Private assessment can be faster for initial diagnosis, though ongoing anti-VEGF treatment is generally available on the NHS.
Finding a specialist ophthalmologist with AMD experience can make a significant difference to the quality of your care — particularly for managing the emotional and practical challenges that accompany progressive vision loss. For an overview of how vision conditions affect professional careers and daily life, see Expert Zoom's coverage of Elton John's experience with vision loss.
Living well with AMD
Judi Dench's openness about her condition has helped many people in the UK recognise that AMD is not something to be embarrassed about or to endure in silence. She has used support magnification technology, audiobooks, and adapted her professional work accordingly.
For people with AMD, low vision rehabilitation services — available through the NHS — can provide practical tools and strategies: large-print materials, screen magnifiers, audio description software, and mobility support.
The Macular Society (macularsociety.org) offers helplines, peer support groups, and practical information for both patients and carers — a resource that complements medical treatment with day-to-day guidance.
This article is for general information only and does not constitute medical advice. If you have concerns about your vision, consult a qualified optometrist or ophthalmologist.
