Dry AMD Treatment: Modern Ways to Slow Progression

Table of Contents

1. What are the dry macular degeneration treatment breakthroughs?
2. How to monitor dry AMD progression with OCT?
3. What are the challenges of dry age-related macular degeneration monitoring?
4. How do I organize efficient dry AMD monitoring in my clinic?
5. Why are optometrists on the front line of early AMD detection?
6. How can OCT insights help support patients emotionally?
7. Conclusion

For many years, dry or non-exudative AMD was seen as untreatable. Most research focused on wet AMD and anti-VEGF therapy.

Today, this paradigm is shifting. Around 30% of patients with age-related macular degeneration are affected by the dry form, which makes finding effective therapies critical. Recently, the first FDA-approved drugs for dry macular degeneration injections have appeared, offering hope to patients with geographic atrophy (GA). Alongside, new physiotherapeutic methods, such as multi-wavelength photobiomodulation, are showing promising results.

Geographic atrophy (GA) is an advanced, irreversible form of dry AMD. It occurs when parts of the retina undergo cell death, leading to progressive vision loss. But even the best dry AMD treatment is incomplete without objective measurement. That’s where modern tools for macular degeneration monitoring come in, and optical coherence tomography (OCT) is now at the core of this process.

 

What are the dry macular degeneration treatment breakthroughs?

The latest dry macular degeneration treatment breakthroughs include:

• Multiwavelength photobiomodulation
• FDA-approved injectable drugs
• AREDS 2-based supplements

In the past, recommendations focused only on reducing risks — quitting smoking, managing blood pressure, and eating a healthy diet.
Now, new approaches to dry AMD treatment combine prevention with active therapies to slow AMD progression and especially the advance of GA.

1. Dry AMD treatment using multiwavelength photobiomodulation

Multiwavelength photobiomodulation for AMD is a promising new treatment. It uses specific red and near-infrared light wavelengths (~590–850 nm) and helps reduce oxidative stress, inflammation, and pigment epithelial cell death.

One of the best-known systems is Valeda Light Therapy, which delivers controlled multiwavelength light directly to the retina.

The LIGHTSITE III clinical trial showed that photobiomodulation can slow the decline in visual acuity and reduce the rate of GA expansion.

Limitations:

• Only 3–5 years of long-term data available
• Requires costly equipment and training
• Effectiveness in late-stage GA remains unclear

2. Dry AMD treatment using FDA-approved injectable drugs

AMD injection drugs approved by the FDA include Izervay and Syfovre.

• Izervay (avacincaptad pegol): A C5 complement protein inhibitor that targets the complement cascade involved in chronic retinal inflammation and damage. Izervay, approved for geographic atrophy secondary to dry AMD, has demonstrated a reduced rate of GA progression in clinical trials.
• Syfovre (pegcetacoplan): A C3 complement inhibitor that blocks the central component of the complement system to reduce inflammation. Syfovre is the first FDA-approved treatment for GA that targets complement component C3, showing a clinically meaningful slowing of GA progression.

Both dry macular degeneration injections have shown the ability to slow GA progression compared to placebo. Although they do not restore vision, slowing vision loss is a meaningful clinical outcome.

Key considerations for injections:

• Administered intravitreally, usually monthly or every other month
• Require doctor training and patient education on risks (e.g., endophthalmitis, increased intraocular pressure)
• Cost and access may limit use

3. Dry AMD treatment using AREDS 2-based supplements

AREDS 2 supplements are antioxidant supplements containing lutein, zeaxanthin, vitamins C and E, zinc, and copper. They can reduce the risk of progression to late-stage AMD by around 25% over five years, according to the AREDS 2 study.

Pros:

• Widely available
• Safe, with low side effect risk
• Supported by strong clinical evidence

Cons:

• Do not directly treat GA
• Cannot replace active therapies such as dry macular degeneration injections or photobiomodulation

How to monitor dry AMD progression with OCT

Effective macular degeneration monitoring relies on OCT. It is the gold standard for tracking retinal changes and predicting GA development.
Without OCT, clinicians are essentially “flying blind” when assessing AMD progression.

Key monitoring parameters of AMD progression

The key monitoring parameters of AMD progression include GA area, drusen, and distance to fovea.

1. GA area

This is the main metric when using intravitreal eye injections. Modern OCT systems provide GA measurements in mm², allowing doctors to objectively track changes over time.

Even if patients don’t notice symptoms, a growing GA area signals disease progression. In FDA trials for Syfovre and Izervay, the GA area was the primary endpoint.

2. Drusen

Drusen vary in number, size, and shape. A reduction or disappearance of drusen on OCT may seem like an improvement, but could actually indicate a transition to the atrophic stage. Regular monitoring helps detect this early.

3. Distance to fovea

The closer GA is to the fovea, the greater the risk of sudden vision loss.

Early detection enables:

• Referral to an ophthalmologist
• Timely conversations about potential vision loss

OCT outputs for AMD progression monitoring and communication

Useful OCT outputs for AMD progression monitoring and communication are heat maps and progress charts.

1. Heat maps

Modern OCT systems use color-coded heat maps to show pigment epithelium thickness and drusen distribution. This visual format helps in several ways:

• Makes interpretation easier for clinicians
• Helps patients better understand their condition
• Encourages patients to stay engaged with treatment

In clinical practice, it serves as a highly effective communication tool.

 

2. Progress charts

Most OCT systems can compare results across visits

• For doctors: Helps guide treatment decisions
• For patients: Provides visual proof of stabilization or worsening

 

The role of objective evidence in patient treatment

Patients may question the value of long-term treatments or costly procedures.

OCT is the gold standard for patient motivation. When patients see actual changes, they’re more likely to agree to treatment.

What are the challenges of macular degeneration monitoring?

Monitoring dry AMD presents technical, organizational, and psychological challenges. Doctors of all levels of experience should be aware of them.

1. Invisible microchanges

Early atrophy or drusen changes may be subtle. Patients may not notice them due to eccentric fixation or slow adaptation.

Without OCT, doctors may miss early GA, delaying treatment.

It is necessary to perform OCT even when there are only minor changes in visual acuity or if the patient reports image distortion (metamorphopsia).

2. Subjective assessment

Ophthalmoscopy reveals only obvious changes. Subtle drusen or early atrophy might be missed.

Relying on patients’ complaints is risky — many don’t notice issues until it’s too late.

That’s why even small optical practices should establish clear referral pathways for OCT exams.

3. Unnecessary referrals

Optometrists or primary care doctors often refer patients to ophthalmologists “just in case,” because they don’t have access to OCT or lack experience interpreting it.

This puts unnecessary strain on specialists. In many cases, nothing new is done after the exam because there are no previous images for comparison.

4. Limitations of OCT devices

Not all OCT devices measure GA or track drusen equally well. Older models may lack automated measurements of atrophy area.

In some cases, referral to a center with advanced OCT is necessary.

How do I organize efficient dry AMD monitoring in my clinic?

Practical tips:

1. Create a baseline chart with OCT images during the first visit.

2. Monitor regularly:

• Every 6–12 months in the early stages
• Every 3–6 months with GA
• Before each intravitreal injection

3. Standardise scanning protocols to minimise variability.

4. Use OCT software tools for image comparison, GA calculation, heat maps.

5. Communicate clearly with patients about drusen, atrophy, and treatment goals.

Why are optometrists on the front line of early AMD detection?

Optometrists play a key role in spotting the early signs of AMD, as they are often the first point of contact in eye care.

They perform initial screenings, provide guidance on lifestyle and supplements, and ensure regular OCT monitoring.

If drusen, pigment epithelial changes, or signs of GA are present, they refer patients to ophthalmologists for confirmation and treatment planning.

How can OCT insights help support patients emotionally?

Patients with dry AMD often ask: “Why bother if it can’t be cured?”
Here, OCT plays an emotional as well as clinical role. Showing OCT scans can:

• Prove the value of slowing AMD progression
• Emphasise patients’ role in preserving sight
• Reassure them that long-term care makes a difference

 

Dry macular degeneration treatment breakthroughs: key takeaways for slowing AMD progression

Modern dry macular degeneration treatment breakthroughs, including FDA-approved injections, photobiomodulation, and AREDS 2 supplements,  have changed the outlook for patients.
Yet treatment alone is not enough. Without consistent macular degeneration monitoring using OCT, the benefits of these therapies may be lost.

The future of dry AMD treatment lies in a partnership between optometrists, ophthalmologists, and patients. Together, with breakthrough therapies and precise monitoring, we can slow AMD progression and give patients the best chance of preserving vision.