Retinal Conditions
Intermediate Dry Age-Related
Macular Degeneration
The term “dry” AMD may be confusing because it encompasses a wide range of clinical presentations. Early stage AMD is observed without intervention. Intermediate stage AMD can benefit from vitamin supplementation and in some cases from light therapy. Geographic atrophy is an advanced form in which patches of tissue slowly lose function and is often associated with significant vision loss. All of these are considered “dry” forms of the disease. In addition, Wet (neovascular) AMD is sometimes referred to as “dry” when it has been controlled with treatment. Ask your BARA doctor about your stage of AMD. The remainder of this handout focuses on the Intermediate stage of AMD, also called Intermediate high risk dry AMD.
What Does It Mean to Have Intermediate Dry AMD?
Intermediate dry AMD is defined by deposits under the retina called drusen as well as clumping or alterations in the pigmented layer under the retina. Vision changes in intermediate dry AMD can include the following:
• Decreased visual acuity (decreased sharpness of small objects or small print)
• Decreased contrast sensitivity (difficulty seeing print without good lighting)
• Mild distortion (waviness of lines or letters)
While distortion and mildly decreased vision are typical in intermediate dry AMD, these symptoms can also be seen in more advanced stages of AMD. Monitoring your vision regularly can be helpful in identifying progression of AMD. Ask your BARA doctor about ways to monitor your vision.
Conversely, distortion and decreased visual acuity can also be caused by a number of other common retinal conditions. Your BARA doctor will recommend diagnostics as needed to distinguish AMD from other diseases that may be present.
Vitamin Supplements in AMD
The Age-Related Eye Disease Study (AREDS) was a six-year clinical trial of 3,640 participants aged 55 to 80 years old sponsored by the National Eye Institute. Researchers found that a combination of antioxidants prevented progression of intermediate stage AMD. The study helped identify optimal vitamin formulations for both smokers and non-smokers.
The AREDS 2 Study subsequently followed more than 4,000 participants for 5 years to investigate the relative benefits of several variations on the original formulas. This study identified a single vitamin formulation which provides the maximum benefit to patients regardless of prior smoking history.
The AREDS 2 supplement did not benefit eyes with early stage AMD or eyes that already had advanced AMD with poor vision. The AREDS supplement is recommended for patients with advanced AMD in one eye if the fellow eye has no AMD or AMD with vision of 20/100 or better. This supplement is not a cure for AMD, nor will it restore vision already lost by AMD.
Photobiomodulation
In November of 2024, the FDA approved the Valeda Light Delivery System, the first direct treatment approved for intermediate stage dry AMD. Valeda has been available in Europe since 2019. In the United States, the treatment is approved for eyes with dry AMD with visual acuity 20/32 to 20/70 and either high risk intermediate findings or non-central geographic atrophy. The photobiomodulation technology uses multiple wavelengths of light delivered in a series of 9 sessions over 3-5 weeks to stimulate retinal cells in order to reduce oxidative stress and inflammation. Each treatment session lasts a few minutes. The series of 9 treatments may be repeated at 4 month intervals.
FDA approval was based on the LIGHTSITE III clinical trial, a double-masked clinical trial in which 100 patients received either light therapy or sham therapy for 2 years. Patients who received the Valeda treatment demonstrated decreased progression to geographic atrophy (advanced dry AMD) and some patient demonstrated improved vision. Experts in our field continue to discuss the available data and its implications, and as with any new therapy, we expect additional data in the near future will guide and refine the use of the technology.
