New Treatments for Geographic Atrophy

Photobiomodulation (PBM) therapy uses specific wavelengths of light delivered to the retina through a tabletop device to stimulate cellular repair processes in the retinal tissue. In November 2024, the FDA authorized a photobiomodulation light delivery system as the first non-invasive FDA-authorized treatment for dry AMD.

The LIGHTSITE III clinical trial showed meaningful improvements in visual letter scores and a significant reduction in new GA onset compared to a sham treatment over a 24-month period. The treatment protocol involves multiple short sessions over a few weeks, repeated on a regular cycle over a two-year course. Because it does not involve needles or medications injected into the eye, it has a distinct side effect profile compared to complement inhibitors.

Complement inhibitors and photobiomodulation work through very different mechanisms. Complement inhibitors suppress the immune-driven destruction of retinal cells. Photobiomodulation uses light energy to support the retina's own repair processes at the cellular level.

These different mechanisms mean the two approaches are not simply interchangeable. Your specialist will assess which option is most appropriate based on your disease characteristics. Research into whether combining these approaches might offer additional benefit is ongoing, and your specialist can discuss what the current evidence supports.

The patients most likely to benefit from current GA treatments are those who still have usable central vision at the time treatment begins. Your retina specialist evaluates the size, location, and rate of growth of your atrophic lesions to determine which treatment is most appropriate for your situation.

Both injectable and non-injectable options require ongoing commitment to maintain their benefit. Treatment is not a one-time event but rather a long-term strategy to protect the vision you have. Starting sooner, while more retinal tissue is still intact, generally offers the greatest potential benefit.

This decision depends on factors beyond just the drug mechanism. Avacincaptad pegol is only available as a monthly injection, while pegcetacoplan can be given monthly or every other month. The every-other-month schedule for pegcetacoplan is associated with a lower rate of wet AMD conversion than monthly dosing, which may influence the recommendation for some patients. Your specialist will review your lesion characteristics, your tolerance for injection frequency, and your medical history to guide this choice. There is no single right answer that applies to every patient.

Yes. There is no cutoff based on how long you have had a GA diagnosis. What matters is your current lesion size, location, and the amount of functional vision that remains. If your lesion is located near or affecting your central vision, your specialist will weigh the potential benefit of slowing further expansion. Even if significant atrophy has already occurred, preserving what remains is a worthwhile goal.

You are unlikely to feel the medication working or notice a visible improvement in your day-to-day vision, since these treatments slow progression rather than restore function. Your specialist measures the size of your GA lesion over time using OCT imaging and compares your rate of growth to what would be expected without treatment. Meaningful assessment typically requires at least six to twelve months of consistent treatment. Slowed lesion growth on imaging is the primary indicator that treatment is effective.

Photobiomodulation is not currently considered a direct replacement for complement inhibitors, nor is it appropriate for every patient with GA. It works through a different mechanism and is administered differently. For some patients it may be the preferred approach, particularly those who wish to avoid injections or who have contraindications to complement inhibitor therapy. Your specialist will assess whether PBM, an injectable treatment, or ongoing monitoring is the right path for your specific situation.

Medicare Part B generally covers physician-administered intravitreal injections when medically necessary, including the complement inhibitors approved for GA. Commercial insurance and Medicare Advantage plans vary and may require prior authorization before treatment begins. Coverage for photobiomodulation therapy is still evolving and may not yet be consistent across plans. Your care team can verify your benefits before your first treatment and help connect you with manufacturer patient assistance programs if cost is a barrier.

Clinical trials can offer access to investigational therapies not yet widely available, and participation contributes to the advancement of GA treatment for all future patients. Whether a trial is appropriate depends on your disease stage, overall health, and eligibility criteria for specific studies. Your specialist can review currently enrolling trials and help you understand what participation would involve, including visit requirements, monitoring protocols, and any associated risks.