The Chris Wolfe Podcast: Why Photobiomodulation Shouldn’t Be Judged Only by Visual Acuity

Christopher Wolfe, OD, FAAO, examines how clinicians should evaluate photobiomodulation for dry age-related macular degeneration (AMD). The key question: should treatment be judged only by visual acuity gains, or also by whether it may affect disease progression in patients whose vision is still good?He reviews evidence related to drusen volume, geographic atrophy (GA), conversion to wet AMD, and other measures of visual function. He also considers treatment frequency, patient burden, and what further research is needed before clinicians can confidently reduce the current treatment schedule.Key topicsWhy visual acuity improvement may not be the only meaningful measure of benefit in dry AMDHow photobiomodulation compares with the preventive goals of AREDS 1 and AREDS 2Findings on drusen volume from the Iovino and LightSite studiesWhat the available evidence does—and doesn’t—show about conversion to wet AMD and development of GAFunctional outcomes beyond standard high-contrast visual acuity, including contrast sensitivity and low-luminance visual acuityWhat may happen when treatment stops, and why ongoing management may be neededThe current treatment schedule discussed in the episode: nine treatments over three weeks, repeated every four monthsWhy evidence is still needed to determine whether fewer treatments or longer intervals can maintain benefitHow clinicians can discuss potential benefits, uncertainty, treatment burden, and patient preferencesTimestamps00:13 — The central question: is visual acuity the only measure of benefit?01:39 — The question for category 3 patients with good visual acuity03:02 — The comparison with AREDS 1 and AREDS 205:00 — Evidence on drusen volume06:25 — What the studies suggest about conversion to wet AMD07:50 — Geographic atrophy findings09:19 — Looking at photobiomodulation through a disease-progression lens10:16 — Functional measures beyond the eye chart11:14 — What happens to measured benefits after treatment stops12:10 — Retreatment intervals and sustaining benefit14:07 — The treatment burden of the current protocol15:02 — The limits of anecdotal evidence when considering fewer treatments15:57 — Wearable and at-home approaches: promising, but not yet a replacement16:50 — The current best-supported schedule discussed in the episode17:20 — The research question that could change clinical practice18:17 — Explaining the evidence and options to patients20:10 — Why visual acuity should not be the only definition of success

AMD I