Review Article

Age-related macular degeneration (AMD) is a bilaterally symmetric disease influenced by genetic, environmental, and local factors. Genetic and environmental factors influence both eyes equally. However, unexpected asymmetry has been reported, with one eye affected more than the fellow eye. Asymmetry within the symmetry is a natural manifestation of AMD. The literature fails to identify the cause of asymmetric presentation in the same individual and warrants clinical research into local factors that influence the two eyes differently. By better understanding its pathophysiology, we can gain new insights into the development of asymmetry. Recent imaging techniques have helped identify early changes and explore the pathophysiology underlying AMD asymmetry. Genetics influences the early stage, but once the drusen area and volume increase, different local or environmental factors can produce synergistic effects, leading to a loss of symmetry between eyes.