A clinical classification system for age-related macular degeneration (AMD) was developed through an evidence-based Delphi process involving 26 AMD experts, 1 neuro-ophthalmologist, 2 committee chairmen, and 1 methodologist. The system categorizes AMD based on fundus lesions within 2 disc diameters of the fovea in individuals over 55 years old. The classification includes: no AMD (no visible drusen or pigmentary abnormalities), normal aging changes (small drusen <63 µm), early AMD (medium drusen 63–125 µm without pigmentary abnormalities), intermediate AMD (large drusen or pigmentary abnormalities associated with medium drusen), and late AMD (lesions associated with neovascular AMD or geographic atrophy). The 5-year risk of progressing to late AMD increases significantly, from 0.5% for normal aging changes to 50% for the highest intermediate AMD risk group. The proposed classification system aims to improve communication and patient care by providing a standardized framework for AMD diagnosis and management. It emphasizes the importance of distinguishing between normal aging changes and early AMD, and highlights the role of drusen size and pigmentary abnormalities in AMD progression. The system is based on the best available scientific evidence and is designed to be clinically usable, requiring only routine office equipment. It also allows for the segregation of patient prognoses with and without therapies. The classification system is a work in progress and may be refined with future studies and community feedback. The proposed system is intended to facilitate efficient evaluation of therapeutic approaches and improve communication among eye care providers and their patients.A clinical classification system for age-related macular degeneration (AMD) was developed through an evidence-based Delphi process involving 26 AMD experts, 1 neuro-ophthalmologist, 2 committee chairmen, and 1 methodologist. The system categorizes AMD based on fundus lesions within 2 disc diameters of the fovea in individuals over 55 years old. The classification includes: no AMD (no visible drusen or pigmentary abnormalities), normal aging changes (small drusen <63 µm), early AMD (medium drusen 63–125 µm without pigmentary abnormalities), intermediate AMD (large drusen or pigmentary abnormalities associated with medium drusen), and late AMD (lesions associated with neovascular AMD or geographic atrophy). The 5-year risk of progressing to late AMD increases significantly, from 0.5% for normal aging changes to 50% for the highest intermediate AMD risk group. The proposed classification system aims to improve communication and patient care by providing a standardized framework for AMD diagnosis and management. It emphasizes the importance of distinguishing between normal aging changes and early AMD, and highlights the role of drusen size and pigmentary abnormalities in AMD progression. The system is based on the best available scientific evidence and is designed to be clinically usable, requiring only routine office equipment. It also allows for the segregation of patient prognoses with and without therapies. The classification system is a work in progress and may be refined with future studies and community feedback. The proposed system is intended to facilitate efficient evaluation of therapeutic approaches and improve communication among eye care providers and their patients.