PHOTOBIOMODULATION (PBM): A New Treatment for “Dry” Age-Related Macular Degeneration

HISTORY AND BACKGROUND:

Age-Related Macular Degeneration (ARMD) is the leading cause of visual impairment for patients over 65 years of age. It is based upon genetic factors, aging factors and environmental factors. It comes in two types: A) The more prevalent “Dry” type, where there are no findings of leakage or bleeding and B) The less prevalent “Wet” type, where new blood vessels form in the retina which subsequently leak, bleed and ultimately impair vision.

In both instances, the retina, which is a thin membrane that lines the inner aspect of the eye, has its center (macula) damaged. This damage to the retinal cells interferes with the ability of a clear image to be projected onto the retina and transmitted to the brain. As a result, the patient who has this disease often will complain of blurry, distorted, or wavy vision. Approximately 20 million Americans suffer from ARMD, with roughly 2 million suffering from “Wet” ARMD, and the remainder suffering from “Dry” ARMD. Roughly, another 2 million will suffer from a severe type of “Dry” ARMD called Geographic Atrophy (GA), in which scaring in the macula is the predominant feature. Many of you may have seen the TV commercial, where actor, Henry Winkler, talks about his father-in-law suffering from GA, and the treatment options available to help it.

PRESENT TREATMENT OPTIONS FOR ARMD:

Over roughly the past two decades, the hallmark therapy for “Wet” ARMD is Intravitreal Injections (IVI). In this therapy, medication is injected into the eye via a very small needle after the eye is anesthetized. It is performed routinely in the office by all retina specialists in the United States. In most instances, prompt diagnosis and treatment can preserve vision, and in some instances, vision can be improved. Treatment and therapy are of course on a case-by-case basis, but in general, the injection therapy is indefinite. As in most instances, stopping treatment will cause the eye to regress. This is a maintenance therapy and not a cure, as patients need to return anywhere from 4-16 weeks for repeat injections. Although stressful at times for patients, due to the commitment for numerous visits, this therapy is far better than the laser treatments we had prior to IVI. The laser would create scars and cause damage to both healthy and nonhealthy retina; hence, treatment with IVI has become the standard of care for “Wet” ARMD at present. Ongoing research will make this therapy obsolete in the ongoing years as we look towards the future for the development of gene therapy, stem cell and pigment transplants.

Over the last two years or so, we have also incorporated therapies for GA. These patients can also be treated with IVI, which slows the process of degeneration. They do not cause healthy cells to grow back, but with injections monthly or every two months, we can significantly slow the rate of GA progression with IVI.

PHOTOBIOMODULATION:

As one can see, we have good proven therapy for roughly 20% of the 20 million sufferers of this disease. How do we manage the remaining 80%? Well, the main treatment for decades for this group was vitamins, in conjunction with no smoking, sunglasses, a good Mediterranean diet, and exercise. The National Eye Institute (NEI) via its AREDS and AREDS2 studies found that by taking supplements we can reduce the risk of progression from intermediate to advanced ARMD by 25%. However, the supplements do not prevent ARMD onset.
This was all we could offer these patients until recently. In a study titled “Lightsite 111,” which was conducted over 24 months, the results from 13 months of the study were published in the November 7th issue of the journal, Retina. The study demonstrated that a therapy called Photobiomodulation (PBM) could prevent the progression of intermediate ARMD (vision 20/32-20/100) and even improve vision. PBM is a light therapy treatment in which patients are subject to light (590nm, 660nm, 850nm) in a series of nine sessions over 3 to 5 weeks every four months. The results of this study showed that patients who were treated with PBM gained a line to a line and a half of vision, were less likely to progress to GA, and were less likely to have their intermediate ARMD progress. This therapy has been in Europe, and over the past two months, was approved by the FDA in the United States. This is a painless procedure for the patient and can be performed by an ophthalmic technician.

SUMMARY:

Photobiomodulation (PBM) is a new therapy using light that can stabilize and improve vision in a group of patients who suffer from ARMD and were previously treated only with vitamins. All initial studies and/or indications show the therapy to be safe and the results have shown an improvement in this subset of patients with ARMD. In a continued effort to provide our patients the best care available, Atlantic Eye is strongly considering the purchase of this equipment.

Paul N. Guerriero, MD, FAAO, FASRS
Diseases of the Retina, Vitreous, and Macula
Atlantic Eye

If you are interested in scheduling a consultation with Dr. Guerriero to determine if you are a candidate for Photobiomodulation (PBM), please call us at 732-222-7373 or use our convenient online appointment form.