Timothy T. Xu, MD
Wills Eye Hospital, Philadelphia, PA
The dry age-related macular degeneration session of Atlantic Coast Retina Club 2026 was moderated by Alexander J. Brucker, MD and Jason Hsu, MD.
Latest Findings from Pegcetacoplan Trials for Geographic Atrophy in AMD
Ferhina S. Ali, MD, MPH
Dr. Ali discussed predictors of geographic atrophy (GA) progression and vision loss in dry AMD to help clinicians identify patients most likely to benefit from complement inhibitor therapy. Analyzing data from the OAKS and DERBY trials, Dr. Ali identified GA growth was associated with fewer intermediate or large drusen, less circular and larger-perimeter lesions, lesions farther from the fovea, and overweight BMI. Better baseline visual function was also linked to faster lesion enlargement. Faster vision loss was associated with higher baseline BCVA, slower reading speed, fewer large drusen, larger low-luminance deficit, and smaller baseline GA size, with several factors remaining significant on multivariate analysis. These findings highlight clinically measurable factors that may inform individualized discussions of GA and should be considered in patient prioritization.
Imaging Biomarkers for Dry Age-Related Macular Degeneration
Justis P. Ehlers, MD
Dr. Ehlers identified ellipsoid zone (EZ) integrity as a strong OCT biomarker of progression from intermediate AMD to geographic atrophy and vision loss. EZ attenuation/loss correlated with faster GA growth and decline in visual acuity, while additional OCT markers such as hypertransmission defects, hyperreflective foci, and drusen volume further inform risk stratification. Eyes with normal EZ tend to remain stable, whereas those with partial or total EZ loss tend to experience meaningful vision decline. These findings suggest that OCT-based biomarkers may help guide patient selection in clinical practice as well as research trials to monitor progression.
Functional OCT (OCT-F) – An AI Powered Algorithm to Follow Retinal Disorders
Caroline R. Baumal, MD
Dr. Baumal discussed functional OCT (OCT-F) as an investigational imaging tool to bridge the gap between retinal anatomy and function in GA, addressing conventional limitations of BCVA and standard microperimetry. BCVA is often unreliable particularly in subfoveal or non-central GA, and microperimetry is limited by practical constraints such as measuring dB level retinal function. OCT-F uses AI-trained models to generate high-resolution maps of retinal sensitivity co-registered to structural OCT. Case studies presented by Dr. Baumal demonstrated that OCT-F can detect functional decline corresponding to GA progression, revealing differences in treated versus untreated eyes that central BCVA alone may miss.
Innovative Imaging: Unveiling New Insights into Age-Related Macular Degeneration
K. Bailey Freund, MD
Dr. Freund emphasized the value of patient-level clinical-pathologic correlations in dry AMD to understand drusen formation and progression. Using high-resolution OCT and histologic data obtained in conjunction with Dr. Christine Curcio, Dr. Freund demonstrated that small, hard drusen and basal laminar deposits often merge or occur in unexpected locations, with lesion evolution influenced by other factors such as choroidal thickness and hyperpermeability. Longitudinal follow-up revealed slow, variable drusen changes and highlights overlap phenotypes, such as pachychoroid spectrum disorder related-related lesions. These findings underscore the heterogeneity of AMD pathology and caution against assuming uniform disease mechanisms since different biological pathways may contribute to the formation of large drusen.
Photobiomodulation: CON
Susan B. Bressler, MD
Photobiomodulation: PRO
David S. Boyer, MD
 |  |
Dr. Bressler presented the cons of photobiomodulation, a novel technology that delivers yellow, red, and near-infrared light in repeated in-office sessions for dry AMD. She argued that the LightSite III trial enrolled only a small, atypical cohort with limited baseline visual impairment, and only a fraction of sham eyes completed follow-up. Reported improvements in visual acuity (2.4 letters over sham) were modest, potentially confounded by regression to the mean, placebo effects, and baseline imbalances, with limited clinical visual significance. Secondary functional outcomes showed no supportive benefit, and a potential safety signal was noted, with higher rates of conversion to neovascular AMD in the treated group.
Dr. Boyer presented the pros of photobiomodulation. To counter Dr. Bressler’s points, Dr. Boyer presented longer-term and post-hoc analyses, including work by Dr. Glenn Jaffe that suggested potential benefits in mitochondrial function, ATP production, and structural preservation (ELM and EZ function), particularly in patients with baseline acuity worse than 20/40. These anatomical analyses reinforce that PBM trials enrolled patients at high risk of GA progression, suggesting that photobiomodulation may be most relevant for this population rather than patients with early AMD or excellent baseline vision.
Overall, photobiomodulation shows promise for slowing functional and structural decline in dry AMD, but evidence remains limited, with some derived from post-hoc analyses, and should be interpreted cautiously. There is certainly plausibility for structural and functional benefit in selected high-risk patients for GA progression, highlighting the need to further clarify optimal patient selection and treatment parameters.
