Age-related macular degeneration (AMD) is a mathematically tractable disease due to the radial symmetry and steep gradients of photoreceptor cell density centered on the fovea. The study proposes supplementing the Early Treatment of Diabetic Retinopathy Study (ETDRS) grid with an additional ring (sETDRS) to capture high rod densities. Photoreceptor and retinal pigment epithelium (RPE) densities in flat-mounted aged-normal donor eyes were recomputed for sETDRS rings. Literature was reviewed for tissue-level studies of aging outer retina, population-level epidemiology studies, vision studies, and the impact of atrophy on photopic visual acuity. The 3 mm-diameter xanthophyll-rich macula lutea is rod-dominant and loses rods in aging, while cone and RPE numbers remain relatively stable. The largest aging effects are accumulation of lipids in drusen, loss of choriocapillary coverage of Bruch's membrane, and loss of rods. Epidemiology shows maximal risk for drusen-related progression in the central subfield, with only one third of this risk level in the inner ring. Rod-mediated dark adaptation studies report greatest slowing at the perimeter of this high-risk area. Vision declines precipitously when the cone-rich central subfield is invaded by geographic atrophy. Lifelong sustenance of foveal cone vision leads to vulnerability in late adulthood, especially impacting rods at its perimeter. Adherence to an sETDRS grid and outer retinal cell populations within it will help dissect mechanisms, prioritize research, and assist in selecting patients for emerging treatments. The macula lutea, defined as a 3 mm-diameter region centered on the fovea, is vulnerable to AMD. The ETDRS grid, originally devised without neuroanatomic considerations, has been found to align with Polyak's regions, making it a convenient tool for assessing the neural retina. The study suggests adding a new ring (near periphery [NP]) to the ETDRS grid to include areas of high rod density. The 6 mm-diameter ETDRS grid can link AMD-relevant findings in histology, molecular assay, clinical presentation, and epidemiology. The study also explores the topographic relationship between foveal cone vision and the formation of high-risk drusen, as well as the distribution of rods and subretinal drusenoid deposit (SDD). SDD and drusen are proposed as two parts of one system for lipid transfer serving rods and cones in a cell type- and regionally-specific manner. The study highlights the importance of understanding the topography of photoreceptors and RPE in the context of AMD. High-quality light microscopy of photoreceptor inner segments in the human retina has enabled single-cell clinical imaging via adaptive optics-assisted scanning laser ophthalmoscopy. Flat mounts enable accurate and unambiguous countsAge-related macular degeneration (AMD) is a mathematically tractable disease due to the radial symmetry and steep gradients of photoreceptor cell density centered on the fovea. The study proposes supplementing the Early Treatment of Diabetic Retinopathy Study (ETDRS) grid with an additional ring (sETDRS) to capture high rod densities. Photoreceptor and retinal pigment epithelium (RPE) densities in flat-mounted aged-normal donor eyes were recomputed for sETDRS rings. Literature was reviewed for tissue-level studies of aging outer retina, population-level epidemiology studies, vision studies, and the impact of atrophy on photopic visual acuity. The 3 mm-diameter xanthophyll-rich macula lutea is rod-dominant and loses rods in aging, while cone and RPE numbers remain relatively stable. The largest aging effects are accumulation of lipids in drusen, loss of choriocapillary coverage of Bruch's membrane, and loss of rods. Epidemiology shows maximal risk for drusen-related progression in the central subfield, with only one third of this risk level in the inner ring. Rod-mediated dark adaptation studies report greatest slowing at the perimeter of this high-risk area. Vision declines precipitously when the cone-rich central subfield is invaded by geographic atrophy. Lifelong sustenance of foveal cone vision leads to vulnerability in late adulthood, especially impacting rods at its perimeter. Adherence to an sETDRS grid and outer retinal cell populations within it will help dissect mechanisms, prioritize research, and assist in selecting patients for emerging treatments. The macula lutea, defined as a 3 mm-diameter region centered on the fovea, is vulnerable to AMD. The ETDRS grid, originally devised without neuroanatomic considerations, has been found to align with Polyak's regions, making it a convenient tool for assessing the neural retina. The study suggests adding a new ring (near periphery [NP]) to the ETDRS grid to include areas of high rod density. The 6 mm-diameter ETDRS grid can link AMD-relevant findings in histology, molecular assay, clinical presentation, and epidemiology. The study also explores the topographic relationship between foveal cone vision and the formation of high-risk drusen, as well as the distribution of rods and subretinal drusenoid deposit (SDD). SDD and drusen are proposed as two parts of one system for lipid transfer serving rods and cones in a cell type- and regionally-specific manner. The study highlights the importance of understanding the topography of photoreceptors and RPE in the context of AMD. High-quality light microscopy of photoreceptor inner segments in the human retina has enabled single-cell clinical imaging via adaptive optics-assisted scanning laser ophthalmoscopy. Flat mounts enable accurate and unambiguous counts