Dry AMD Treatment: How to Slow Progression with Modern Approaches

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 considered untreatable. Most efforts were focused on treating the wet or exudative AMD with anti-VEGF drugs. However, this paradigm has recently shifted.

The first FDA-approved drugs appeared recently to treat geographic atrophy (GA), which affects 30% of patients with dry AMD. Additionally, new physiotherapeutic methods, such as multi-wavelength photobiomodulation, have emerged.

Geographic atrophy (GA) is an advanced, irreversible form of dry age-related macular degeneration (AMD). It develops when areas of the retina, the light-sensitive tissue at the back of the eye, undergo cell death (atrophy), causing progressive vision loss. 

However, even the best dry AMD treatment is ineffective without an objective way to measure its success. Updated guidelines suggest advanced tools for monitoring progression, and optical coherence tomography (OCT) is at the core of this process.

What are the dry macular degeneration treatment breakthroughs?

The dry macular degeneration treatment breakthroughs include multiwavelength photobiomodulation, FDA-approved injectable drugs, and AREDS 2-based supplements. Unlike older recommendations focused on reducing risk factors — quitting smoking, managing blood pressure, and eating a healthy diet — these new approaches for dry AMD combine prevention with active treatment strategies to slow the progression of GA.

1. Dry AMD treatment using multiwavelength photobiomodulation

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

One of the most well-known systems used for this approach is Valeda Light Therapy, which delivers controlled multiwavelength light to the retina in a non-invasive manner.

The LIGHTSITE III clinical trial (2022) showed that photobiomodulation significantly slowed the decline in visual acuity and reduced the rate of GA expansion.

Limitations:

• Limited long-term data (only 3–5 years available)
• Requires expensive equipment and trained personnel
• Unclear effectiveness in late-stage GA

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.

Usage considerations:

• Administered via intravitreal injections, usually monthly or every other month
• Doctors need training; patients must be informed about risks (e.g., endophthalmitis, increased IOP)
• Cost and availability may be barriers

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:

• Easily accessible
• Low risk of side effects
• A strong evidence base

Cons:

• Does not directly affect GA
• Cannot replace active treatments like injections or photobiomodulation

How to monitor dry AMD progression with OCT?

To monitor dry AMD progression effectively, OCT is essential. It is the gold standard for tracking structural changes in the retina. Without OCT, clinicians are essentially flying blind when it comes to assessing disease progression and predicting geographic atrophy (GA) development.

What are the 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

What are 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 dry age-related 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?

Here’s how you can organize efficient monitoring in your clinic:

Tip 1. Create a baseline chart

During the first visit, perform a detailed OCT scan to measure GA area, evaluate drusen, and record distance to the fovea. Save the images or print them for future comparison.

Tip 2. Monitor frequently

• Early stages: every 6–12 months
• With GA: every 3–6 months
• When treated with intravitreal injections: before each injection

A reminder system helps with patient compliance.

Tip 3. Standardize your protocol

Use the same scanning protocols every time to reduce variability.

Tip 4. Use OCT software tools

Modern systems offer:

• Image comparison
• Automatic GA area calculation
• Heat map visualization

Tip 5. Communicate clearly with patients

Use simple language:

• These are areas of atrophy, and we’re measuring them
• These bright spots are drusen we’re monitoring
• The goal is to slow the growth of these areas

Educated patients are more engaged in their care.

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?

Explaining a chronic, progressive condition like AMD to elderly patients can be difficult. Motivating them to return for regular follow-ups is often even harder.

Many ask, “Why bother if it can’t be cured?”

OCT insights can support both understanding and emotional reassurance. A thoughtful approach may include:

• Explaining that treatment helps slow vision loss

• Emphasising their active role in preserving sight

• Using OCT scans to show visual proof of stability or progress

Conclusion

Modern dry AMD treatment is no longer a dead end. With FDA-approved medications, photobiomodulation, and effective supplements, optometrists can significantly impact disease progression.

But none of this works without quality monitoring. OCT reveals what the eye can’t see and helps guide clinical decisions while motivating patients.

The ultimate goal is to partner with patients in preserving their vision. This isn’t a one-time visit—it’s a long-term commitment. The stronger the support, the better the chances of maintaining central vision and seeing meaningful results from dry AMD treatment.