Management of Wet AMD Progressing to Dry Atrophy

Diagnostic Confirmation and Treatment Algorithm

The American Academy of Ophthalmology recommends stopping anti-VEGF therapy if OCT confirms absence of active exudation and the backshadowing represents fibrotic scarring or geographic atrophy, then transitioning to AREDS2 supplementation and vision rehabilitation services 1, 2
OCT imaging is recommended to definitively confirm absence of subretinal or intraretinal fluid, with fluorescein angiography and OCTA as additional diagnostic tools if necessary 1, 2

Discontinue anti-VEGF injections immediately if no active exudation is confirmed, as continued injections provide no benefit for fibrotic scarring or geographic atrophy 1, 2
Initiate AREDS2 supplementation to reduce risk of progression in the fellow eye by up to 36% over 10 years, with a formulation including vitamin C, vitamin E, zinc 25mg, copper, lutein 10mg, and zeaxanthin 2mg 2
Refer to vision rehabilitation services immediately for optical/electronic magnifying devices, bright lights, and reading aids to optimize remaining functional vision 1, 2, 3

Monitor the fellow eye aggressively every 6-12 months even without symptoms to detect asymptomatic CNV at a treatable stage, as patients with advanced AMD in one eye remain at exceptionally high risk 1, 3
Enforce smoking cessation as this is the only modifiable risk factor that significantly impacts disease progression 1, 2
Set realistic expectations with the patient that central vision loss is common but total blindness is extremely rare, and that vision rehabilitation optimizes existing function rather than restoring lost vision 2, 3
Screen for depression and Charles Bonnet syndrome, which frequently accompany severe central vision loss, and refer for professional evaluation if present 3