Atrophic age-related macular degeneration (AMD) is a degenerative disorder of the central retina that greatly increases with age. This complex disease is mainly based on a genetic background but environmental factors are most likely responsible for modulating the individual course of the disorder. Various mechanisms are thought to underlie this chronic disorder. Besides defective inflammatory control pathways, increased susceptibility to oxidative stress and defective clearing mechanisms of waste products, primary atrophy of photoreceptors and choroidal capillaries may also lead to the typical clinical signs and symptoms of AMD. Therapeutic approaches therefore aim at modulation of the different disease pathways which probably differ from individual to individual. In the future customized therapeutic strategies are expected to be of great value to slow down disease progression or even prevent outbreak of the disorder.