Julie Poteet, OD, MS, CNS, FONS, is passionate about macular degeneration care and is always searching for new ways to preserve sight. Now, she sees promise in a breakthrough therapy recently authorized by the FDA—the first treatment for vision loss in early and intermediate dry age-related macular degeneration (AMD). The therapy, known as photobiomodulation, utilizes low-level light therapy to target mitochondrial dysfunction, a key factor in the progression of the disease.
Photobiomodulation delivers brief, serial illuminations with near-infrared light—ranging from 600 to 1,000 nanometers—using a laser or light-emitting diode. The retina contains more mitochondria than any other tissue in the body, and by enhancing mitochondrial function, the therapy initiates a photochemical reaction at the cellular level. This process stimulates complex IV in the electron transport chain, increasing respiratory function and reducing oxidative stress and inflammation. Since mitochondrial dysfunction is a major driver of chronic inflammation in AMD, improving mitochondrial performance may help slow or even alter the trajectory of the disease.
According to Dr. Poteet, the initial trial results are promising. Patients showed improvements in visual acuity, gaining letters on the eye chart, and the therapy demonstrated potential to slow the progression of geographic atrophy, a late-stage form of AMD. Importantly, the noninvasive nature of the treatment makes it an attractive option for both patients and practitioners, with no serious adverse effects reported in trials so far.
OPTOMETRISTS AS FIRST-LINE DEFENDERS
The therapy is expected to be available in some retina specialist offices by the end of the year, but Dr. Poteet envisions a broader role for optometrists. Since optometrists are often the first to detect early signs of macular degeneration, they are in a prime position to offer this therapy before patients require more invasive treatments, such as injections for wet AMD. She says that the goal is to integrate photobiomodulation into primary eye care, giving optometrists a new tool to intervene early and potentially change the course of the disease.
Dr. Poteet stresses that AMD is not an inevitable march toward blindness. Lifestyle factors play a significant role, and there are steps patients can take to reduce their risk. Research from the National Institutes of Health highlights the protective benefits of a Mediterranean-style diet, particularly the inclusion of fatty fish. Dr. Poteet recommends “SMASH” fish—salmon, mackerel, anchovies, sardines and herring—twice a week to lower the risk of progression from intermediate to advanced AMD. While fish oil supplements have their benefits, studies suggest the whole fish provides greater protective effects.
For those with a family history of AMD, the implications of this new therapy are especially important. Genetic predisposition plays a role, but environmental factors can influence whether those genes lead to disease. If research continues to support photobiomodulation’s effectiveness, Dr. Poteet believes it could become a critical early intervention tool, helping to preserve vision before irreversible damage occurs.
“This is a big deal,” Dr. Poteet says. “If the research continues to play out, this could truly transform the way we practice and save sight in a way we haven’t been able to before.”
