Beyond Aesthetics: Photobiomodulation Therapy for Dry AMD

Although photobiomodulation (PBM) therapy has gained public recognition as an aesthetics treatment, the focus of this month’s issue, it’s worth noting that PBM has expanded into a treatment for dry age-related macular degeneration (AMD). What’s more, thanks to optometric scope-of-practice expansion, ODs in some states are able to perform it. So, the questions become: How does it work, and who are the ideal candidates?

PBM is a noninvasive intervention that activates photoacceptors in the mitochondria of the retina, improving adenosine triphosphate, modulating intracellular signaling molecule pro- duction, such as reactive-oxygen species and nitric oxide, and setting off secondary effects that produce uninterrupted alterations in cell function and viability¹. As a result, it significantly decreases the risk of incident geographic atrophy (GA)².

Regarding patient candidacy, Carolyn Majcher, OD, FAAO, FORS, who practices at the Northeastern State University Oklahoma College of Optometry, in Tahlequah, Oklahoma, says ideal patients display high-risk biomarkers for future GA. These biomarkers include reticular pseudodrusen (subretinal drusenoid deposits), intraretinal hyperreflective foci, drusen with hyporeflective cores, OCT-reflective drusen substructures, collapse of large soft drusen, drusenoid pigment epithelial detachment, choroidal thinning, and choriocapillaris hypoperfusion via OCT angiography. Additionally, subretinal pigment epithelial hyperreflective columns (intermittent choroidal hypertransmission) is common in these patients, she notes.

The treatment is contraindicated in photosensitive patients, those using photosensitive-causing drugs, such as antibiotics, those who have light-activated neurological disorders, such as epilepsy, and/or who have coexisting retinal disease, points out Cecelia Koetting, OD, FAAO, assistant professor in the Department of Ophthalmology at the University of Colorado Anshutz Medical Campus, in Aurora, Colorado.

Optometrist Mila Ioussifova, who practices in Portland, Oregon, says ideal patients are motivated and able to follow the treatment schedule (nine sessions over 3 to 4 weeks, typically 3 times a week).