What You Need to Know About Dry AMD and Geographic Atrophy

David S. Liao, MD
Dr. David S. Liao is a board-certified ophthalmologist at the Retina-Vitreous Associates Medical Group in California. He specializes in the medical and surgical treatment of diseases of the retina and vitreous. His main areas of interest include macular degeneration, diabetic retinopathy, disorders of the vitreomacular interface, and retinal detachment repair.

Listen to the discussion:

Duration

00:40:11


BrightFocus Foundation
What You Need to Know About Dry AMD and Geographic Atrophy
Aug 26, 2020
1:00 p.m. EDT

Please note: This Chat may have been edited for clarity and brevity.

MICHAEL BUCKLEY: Hello, I’m Michael Buckley with the BrightFocus Foundation. Welcome to today’s BrightFocus Chat, “What You Need to Know About Dry AMD and Geographic Atrophy.” If this is your first time at a BrightFocus Chat, welcome. Let me tell you a little about BrightFocus and what we’ll do today. The BrightFocus Foundation is a nonprofit based in Maryland, and we’re funding about 200 research grants around the world to try to find better treatment and hopefully cures for macular degeneration, glaucoma, and Alzheimer’s disease. We share the latest news from these scientists with families who are impacted by these diseases. And that’s why we do the BrightFocus Chats. We’ve been doing them since 2014, and we do it as an opportunity for you to hear directly from some of the leading experts in the field of vision disease. Let me tell you about today’s discussion, “What You Need to Know About Dry AMD and Geographic Atrophy.” We have a new guest with us today from Los Angeles, California. It’s Dr. David Liao. He is an ophthalmologist based in Los Angeles, specializes in medical and surgical treatments of retinal disease, and he is here today to kind of give us an overview of dry AMD and answer some of your answers. So, Dr. Liao, thank you very much for joining BrightFocus today.

DR. DAVID LIAO: Thank you, Michael. I am very glad to be here.

MICHAEL BUCKLEY: I’d like to start with the Career Day question. Why did you want to go into science and medicine?

DR. DAVID LIAO: A lot of people ask me that. When I went to medical school, we were all kind of bright-eyed, fresh, new medical students trying to find out which part of medicine that we wanted to go into. I think there are very few bad choices. Ophthalmology just seemed like a field that you could readily do things to help people improve vision, and that’s turned out to be true; even in the time that I graduated from medical school, the amount of diseases that we can treat and the amount of vision we can preserve has really just dramatically increased, so it’s turned out to be a great choice, and I’m lucky to be a part of the field.

MICHAEL BUCKLEY: That gives us great hope for the future—your perspective, your experiences so far. So, Dr. Liao, let’s start with diagnosis. What type of doctor or medical practice would diagnose dry AMD?

DR. DAVID LIAO: Let’s start off with just the basics, I think most of your listeners are familiar with macular degeneration, in general. It’s a disease that affects the central vision in older folks, and there are two types of macular degeneration: the dry, which we are going to focus on today, and the wet, which we may touch upon later. But what usually brings folks to the eye care professional or the eye doctor is some decrease in vision. Perhaps you’re just at a certain age and you should get eye exams on an annual basis, but most people go see their ophthalmologists if they’ve had a family history or some other problems. They might go see their retina specialist, and a lot of people see their local optometrist, as well. So, basically, your general eye care professional will help you out with that.

MICHAEL BUCKLEY: And when that visit happens, how is dry AMD diagnosed?

DR. DAVID LIAO: Once you discuss your symptoms with your doctor, he or she will know what tests to run. The most simple test that you can do is just a simple dilated eye exam, where they dilate your pupils and look inside your eye and they look for characteristics of macular degeneration starting to appear in the retina. A lot of times there are other tests that they could do, like fundus photos—taking pictures even without the eyes dilated—and sometimes they’ll offer an OCT test, which is an optical coherence tomography test, where they actually look at the contour of your retina and see if there are any deposits or any swelling inside the retina, and then there are other types of special photographs that you usually get into later, like special filters known as fundus autofluorescence or even angiograms with the dyes to look at the blood flow within the retina.

MICHAEL BUCKLEY: On the whole, at what age point in life does dry AMD tend to surface and be diagnosed?

DR. DAVID LIAO: The true name of it is age-related macular degeneration, so we know that the incidence of it increases with age. One large study—the Framingham Study—did show that the risk of getting AMD when you are 65 to 74 … in that population that they studied was about 6 to 7 percent as age increased—so, for example, after age 75, almost 19 to 20 percent of the patients had signs of AMD—and so we know with our population, as folks get older, we’re going to start to see more and more of this in folks who come in for eye exams.

MICHAEL BUCKLEY: That’s a really interesting correlation with age, and all of us want healthy aging, so who is at risk? Who is most at risk for developing dry AMD?

DR. DAVID LIAO: That’s a good question. A lot of people have family members with AMD and so forth, and I think the good way to look at it is there are things you can do things about, and there things you can’t do things about. So, age is the number one risk factor. Unfortunately, I’d like to do something about that, but I can’t, so that we take as time goes on. Family history is also an important risk factor, but not 100 percent. It does increase your risk, though. Now, things that you can do things about … for example, smoking. We know that smoking or history of smoking does tend to make AMD worse. High body mass or obesity can make it worse. High blood pressure can make it worse, as well, and other factors, such as diet—eating a diet that’s low in antioxidants may predispose you to higher risk—and other things that we do know are also correlated with it that we can’t do anything about: gender and ethnicity. So, what I like to tell patients is there are things you can’t do things about and things like diets, smoking, controlling blood pressure that you can do that, and those are under our control and we should do our best to try to keep those well controlled.

MICHAEL BUCKLEY: Sounds like a metaphor for life in terms of what you can do [laughter] A metaphor for 2020.

DR. DAVID LIAO: Exactly.

MICHAEL BUCKLEY: Continuing that patient journey, so someone has come to your practice or some practice and they’ve been diagnosed with dry AMD. How do you explain to them what you’ve just diagnosed them as having?

DR. DAVID LIAO: Starting off basically, again—the macula, that’s the central part of the retina. So, the retina is just like the film in a camera. It allows you to take pictures, and so, if your retina isn’t working well, the pictures that you take won’t be as good. And when you look at AMD, it’s easy, I think, to split it up into dry AMD and wet AMD. Wet AMD, you’ll get bleeding and sometimes swelling in the retina. That’s why we call it wet AMD. That’s a more advanced stage of it. Folks, when they get diagnosed, usually at first they have dry AMD, and that’s an earlier form, and you might not have that many symptoms. When the doctor looks in, he or she may look at the retina, look at the macula, and start to see drusen, which is these fatty, yellow deposits underneath the retina. And they can be very small at first, and over time they can grow, and there can be changes in the layers underneath the retina. Most folks don’t have a lot of problem with dry macular degeneration, but there are advanced forms of dry macular degeneration. In particular, one is known as geographic atrophy, where the macula and the layers underneath the retina thin dramatically, and that can cause a loss of vision. It can cause blind spots, difficulty reading, and difficulty recognizing faces, and that’s the more advanced form. Most people that come in have a mild, early dry macular degeneration, and we just talked about lifestyle modifications and so forth for that.

MICHAEL BUCKLEY: I would think that a lot of folks who are diagnosed as having dry AMD, when they hear you talk about the more advanced forms, wonder is that inevitable? If somebody has dry AMD, will they get the geographic atrophy you mentioned? Will they get wet AMD?

DR. DAVID LIAO: This is like any other disease—a continuum. We can’t tell you just by looking at you how things will progress in the future—although there are risks factors, and things looking more severe confer more risk—but the vast majority of people who have macular degeneration will retain the dry type of macular degeneration. Only about 10 to 15 percent of people will get the wet macular degeneration and end up needing the monthly injections to control the bleeding and the swelling, so it’s not inevitable, and the current recommendations are to take the AREDS vitamin that many of your listeners are probably taking to decrease the risk of progressing from dry to wet macular degeneration.

MICHAEL BUCKLEY: And just for listeners who might be new to this, would you mind telling our audience about AREDS … about these nutritional supplements that you mentioned?

DR. DAVID LIAO: We’ve known for a long time that nutrition plays a role in the worsening of macular degeneration. There are these landmark studies called the AREDS studies, and they looked at the role of certain nutrients in preventing more advanced forms of macular degeneration. Specifically, the AREDS2 vitamins that are out now contain vitamin C, vitamin E, zinc, copper, lutein, and zeaxanthin. And these have been shown that, when they’re taken over long period of time, they can decrease the risk of progression to wet macular degeneration. And there are a lot of vitamins out there. There are a lot of different brands, like PreserVision®, Ocuvite®, or ICaps®. You know, I’m not espousing any particular brand or anything, but that formula in it of itself has been shown to prevent or lessen the risk of progression.

MICHAEL BUCKLEY: Dr. Liao, we’ve got a couple of questions submitted from our listeners that I think fit in very well with this part of the conversation where we’re talking about when you diagnosis someone with dry AMD, some questions or concerns. One of them is if somebody has dry AMD, will they lose their driver’s license?

DR. DAVID LIAO: That’s a very important question, because our driver’s license is very important for mobility independence, and the vast majority of folks with AMD or dry AMD have good vision and see well enough to drive. Each state has its own regulations, but here in California, you only need one eye seeing at a level of 24 or better, so most folks with AMD qualify for that. And I do have patients who, perhaps, don’t qualify or have not passed the eye test at the motor vehicle department, and they take a driver’s test and they get their license. In folks who have unfortunately lost of a lot of vision, sometimes different states have different programs where you can use vision aids like special telescopes and so forth to drive. So, there are a lot of different options, but rest assure, most people with macular degeneration retain the ability to drive, from a vision standpoint.

MICHAEL BUCKLEY: That’s good to know. I’ve had a few questions submitted about the anxiety at this point and the hope that … what can people do who have been diagnosed with dry AMD? What can they do to hold onto their vision for as long as they can?

DR. DAVID LIAO: We talked about the modifiable risk factors. First and foremost, taking the vitamin supplements as recommended by your doctor, decreasing weight, avoiding smoking, controlling blood pressure, and—we’ll talk about this a little bit later—there are lots of new research studies and potential therapies that are coming out to address dry macular degeneration to try to prevent it from getting to an advanced stage like geographic atrophy or wet macular degeneration. So, hopefully, in a few years, we will have new treatments that are available that can slow the progression of the disease. It might not necessary cure it, but it will maintain it at a level where vision is really not affected.

MICHAEL BUCKLEY: If somebody were to take a lot of those steps that you outlined, is there sort of a timeline or a pace or a progression of how vision loss occurs when somebody has dry AMD?

DR. DAVID LIAO: Typically, this is on an order of years. For example, it would depend on how many drusen there are and how large the drusen are and how fast that progresses. Usually when you start seeing atrophy, it starts in not right in the center of the vision but will start off to the sides of the macula, and those areas of atrophy may be associated with scotomas or little blind spots that are there, and those take several years to slowly grow and get bigger. And, usually, the last part of the vision that is affected is right in the center. And again, that does take years to happen, but when that does happen, unfortunately, it’s very difficult to read or recognize faces, because that central vision is not functioning as well as it was before.

MICHAEL BUCKLEY: For our listeners, scotomas are blind spots? Is that what you just said?

DR. DAVID LIAO: Yes. They’re little blind spots where the retina isn’t working quite as well. So, if you can imagine, you have little holes or spots in the film that aren’t working very well, and so, when you’re taking a picture with that film, there will be little spots where the vision is not quite as clear. And you might not notice that, for example, when you’re looking outside, but a lot of times you’ll notice that when you’re reading—for example, you might notice as you’re following a line on a page that certain letters disappear or certain parts of the line aren’t quite there or blurry, and that may be a small scotoma that’s forming from the macular degeneration.

MICHAEL BUCKLEY: Let’s get to that point. Are there treatments for a scotoma?

DR. DAVID LIAO: At this point, we don’t really have good treatments for dry macular degeneration that are approved other than the vitamins, so folks with … that are being affected with those early changes, usually they’ll use more light to read, more magnification. But this really does point out the need for treatment for this to prevent these scotomas from getting bigger and really starting to affect the vision more in day-to-day life.

MICHAEL BUCKLEY: For our audience, how would you describe the difference between dry AMD and geographic atrophy?

DR. DAVID LIAO: Dry AMD really encompasses a whole spectrum of changes, so the early form, you just get these … the drusen changes, and as the drusen get larger, then the dry AMD becomes more severe and geographic atrophy really is the “end stage of dry macular degeneration,” where the overlying retina starts to atrophy and thin in conjunction with the layers underneath the retina. And in those areas, the retina doesn’t work well, and the vision is compromised in that area. As bad as that sounds, fortunately, that usually only encompasses the central vision. Your peripheral vision is maintained in macular degeneration, so patients don’t need to worry about, for example, not being able to navigate around their home or being able to feed or care for themselves—that’s not an issue, but loss of central vision is very debilitating as you can imagine.

MICHAEL BUCKLEY: We have a few questions about geographic atrophy. One of the callers is wondering, do you take the AREDS supplement with geographic atrophy, or is that just for an earlier stage of dry AMD? Essentially, is the AREDS something that stays with you during this potential progression?

DR. DAVID LIAO: The goal of the AREDS is actually to try to prevent or decrease the risk of getting … progressing to wet macular degeneration. So, typically, when you have moderate signs of dry macular degeneration, not necessarily geographic atrophy, that’s when your doctor will start prescribing or recommending the AREDS to you. It doesn’t necessarily prevent the progression to geographic atrophy, but there’s still an ongoing risk, even if you do have geographic atrophy for progression to wet macular degeneration, and that’s why it’s still important to take the AREDS supplements.

MICHAEL BUCKLEY: One of our listeners is wondering about the injections you mentioned for wet AMD. Can those be used proactively in a preventive way for people with the forms of dry AMD?

DR. DAVID LIAO: Typically, we only use that for wet macular degeneration. They are very effective at decreasing swelling, stopping bleeding in wet macular degeneration, but they typically don’t have an effect on the progression of dry macular degeneration. There have been studies looking at whether it would be useful for folks to have injections beforehand, but I think the jury is still out on those. There would be a lot of injections for something that, perhaps, might not happen, so most people … they just get injections once they have wet macular degeneration. We’ll talk about treatments later on—new treatments that might be injectable for dry macular degeneration, but those are new medicines that haven’t been approved yet.

MICHAEL BUCKLEY: That’s good to know. At this point in a patient’s journey on to more advanced forms of AMD, what type of advice do you give the patient and their family—their caregivers, for lack of a better word—of making the best of this for doing the best they can day to day? Is there particular advice that you give to families at this point?

DR. DAVID LIAO: At this point, we don’t necessarily have a cure, but we do focus on trying to maximize the vision that you do have. For example, we often send folks to low vision therapists we recommend … who may recommend magnifiers, different other gadgets—to maximum the vision that you do have and work around any disability that you might have. We also focus on what to look for if the macular degeneration’s progressing. For example, we give folks the Amsler grid that you’re familiar with—that little grid card to look for any new distortion or scotomas—and there are also devices at home—for example, one’s called the ForeseeHome monitoring device that patients can use to check daily for any new changes in their vision. And then we want to … if they do progress to wet macular degeneration, we want to treat that as soon as possible to prevent any lingering consequences from that.

MICHAEL BUCKLEY: I know you seem hopeful about the future of dry AMD, and I know you said that there is some encouraging research in the works. Would you want to give us a little update on what the future holds?

DR. DAVID LIAO: When I was coming out of medical school, there really wasn’t any treatment for wet macular degeneration, and now, I think we have … as an ophthalmologist, we have a pretty good handle on that—or at least good treatments—and then there weren’t recently any good treatments for dry macular degeneration, but I think the research scientists have come up with better understanding of what’s going on in dry macular degeneration. It seems to be that in drusen, these are probably sites of some ongoing low-level inflammation that’s causing damage to the photoreceptors there, to the layers underneath the retina, and one of the kind of hotter topics of interest is the complement cascade. This is a part of our immune system that usually helps us fight off infections; however, we know that these molecules are localized within the drusen, and the new therapies are focusing on downregulating this inflammation to try to prevent the spread of geographic atrophy. So, for example, if we could slow the growth of the scotomas and prevent them from getting into the central vision or delay it, that would be very helpful. There are a number of ways that they are doing that. One, as we talked about earlier, is injectable medications that are injected, just like the shots that you get for wet macular degeneration, but they’re focused on downregulating the activation of complement inside the eye, and some of the preliminary studies have actually shown that it does slow down the growth of these geographic atrophy lesions significantly in patient that have had these injections for a period of time.

There are other approaches that are going on—for example, gene therapy. There’s a company out there that is investigating surgically delivering an engineered viral bullet, if you will, underneath the retina to try to upregulate certain factors in the retina and, therefore, decrease inflammation. That will be a very interesting study. There are other things like photomodulation, where folks are trying to enhance retinal function or even decrease the volume of the drusen by exposing the retina to certain wavelengths of light. We also know that the cells—the photoreceptors—that are responsible for vision are being damaged, and that they are dying, basically, in dry macular degeneration. We know certain drugs will protect nerves cells, and retina cells are … you can think of them as specialized nerve cells. So, there are studies in which they’ve implanted some of these medications into the eye to try to slow down, again, the progress of geographic atrophy lesions, and those have shown to have some effect as well. Now, these are for prevention.

Of course, there are some folks that have already had macular degeneration for some time. Their geographic atrophy is quite large, so slowing things down wouldn’t necessary help, but for those folks, there are actually other approaches, such as stem cells trying to replace the cells that have been lost. For example, the retinal pigment epithelium that we also know is decreased or goes away in geographic atrophy—there have been trials to try to implant those types of cell underneath the retina to try to repopulate them so they can support the retina better and perhaps improve vision. So, there are a number of things that weren’t being done just 5 years ago, so it’s a very exciting time, and hopefully some of these treatments will turn out to be helpful and be approved.

MICHAEL BUCKLEY: A listener asked about some research. He had heard that there is a clinical trial using alpha lipoic acid. I was just wondering if that is something that you are familiar with and want to shed some light about that?

DR. DAVID LIAO: Alpha lipoic acid is a molecule that was being investigated to treat geographic atrophy because of its antioxidant properties. They did a trial with geographic atrophy and oral alpha lipoic acid. The results, actually, I believe just came out earlier this month. Unfortunately, they didn’t show a strong effect at preventing geographic atrophy or improving vision.

MICHAEL BUCKLEY: The big picture … I know you mentioned a lot of exciting areas. Do you have a rough timeline of when the average patient might see some of these things? Is this months, years, decades? What do you see the pace is for the treatments and prevention landscape changing?

DR. DAVID LIAO: For example, one of the studies that I and my partners here at the practice were involved in was a molecule called pegcetacoplan. It’s made by Apellis Pharmaceuticals, and it also goes by the name APL-2, but we were involved in what’s called the Phase 2 trial, when the earlier trials … and that data came out fairly recently, and now they’re enrolling in the Phase 3 study, which is a larger-scale study, which we’re also involved in. They’re finished recruiting all their patients for that, so hopefully we’re going to expect the results from that trial later next year, maybe in the spring or so. If the results are positive—again, that the injections slow the rate of geographic atrophy—we’ll, hopefully, have the approval soon thereafter, perhaps in a couple of years.

MICHAEL BUCKLEY: Let’s stay on the topic of clinical trials for a second because I always feel like “clinical trials” is one of those terms that everybody has heard of but maybe not … people don’t actually know that much about it. It’s kind of a term you hear bounced around. I was wondering, Dr. Liao, in your own practice, when someone asks about clinical trials, what do you tell them to think about or to do or to know to see if a clinical trial is a good avenue for them?

DR. DAVID LIAO: That’s the best approach—I think it would be to talk to your doctor and let them give you all the benefits and all the risks to the clinical trial. I think clinical trials serve a very useful purpose, where a lot of the drugs are … pretty much all of the drugs that we use today—for example, the injections that we do for wet macular degeneration—have gone through clinical trials, and we need that to establish that they’re efficacious and that they’re safe. Certainly, participation in clinical trials really helps us as a society bring new therapies online, and sometimes you can get these new therapies years before they are available on the market. For example, folks with wet macular degeneration, when there was previously no cure, they were receiving their injections for years, and that likely benefited them quite a bit because they saved a lot of their vision. But clinical trials are not without risk. They’re not guaranteed to work. There are some medications that end up not working, but it’s the responsibility of the doctor who’s is running the trial and the company who’s trying this new drug to keep patients safe, and so, there are safeguards in place. I tell my patients that if they are interested in a clinical trial, they’re not obligated to stay in the clinical trial; they can exit the clinical trial at any time. It’s something that is a totally voluntary decision and can help patients and can help society as a whole.

MICHAEL BUCKLEY: I am wondering if you could explain the complement cascade again. It’s a term that a lot of people aren’t familiar with. This listener is wondering if you could explain that again—what exactly a complement cascade is?

DR. DAVID LIAO: In the age of coronavirus, we’ve all been hearing about how our immune system helps us fight infections, and some of these … one part of the immune system is to specifically recognize different bacteria and target them. If you get infected with a coronavirus, then your cells make antibodies to target that specific infection, but there’s another part of the immune system—the innate immune system—and the complement cascade is part of that. So, when it recognizes, in general, foreign material—for example, bacteria, for instance—then it releases these factors that promote inflammation and attracts cells to help clear the infection. We know that in dry macular degeneration, they’ve shown that these factors … this is known as a complement cascade, so there are all these little different molecules that kind of come together, and once they are activated, activate this complement cascade. And we know that these factors are located within the drusen that is part of dry macular degeneration, and so these drugs—for example, the Apellis drug—are targeting a gateway factor—that C3 or C3B molecule—that’s within the complement cascade to prevent activation and the downstream inflammation that occurs. So, basically, by blocking the cascade, we’re blocking the inflammation that’s leading to the geographic atrophy.

MICHAEL BUCKLEY: We have a listener who says they’ve heard a lot about stem cell therapy for other medical issues, and they are wondering if stem cell therapy is something that holds promise for vision?

DR. DAVID LIAO: There have been stem cell trials for dry macular degeneration and other diseases that affect the retina. There was a recent update on some trial results, I believe, from OpRegen. They are using what’s called a human embryonic stem cell–derived retinal pigment epithelium. So, basically, if you recall, there’s the retina, and the underneath that, there’s the retinal pigment epithelium, and that’s lost to geographic atrophy. So, what they were trying to do was surgically implant those cells within the area that’s damaged by the atrophy to try to regenerate them and support the retina better. The first few groups—this is an early trial—the first few groups, they at least stabilize the vision and now they have gone on and done a few more patients, and they’ve shown that about five or so patients have actually had a modest increase in their vision. I believe the average was 20/250 to around 20/200, but again, it’s an early trial, and there are other stem cell trials that are ongoing, but that’s really encouraging that you could even replace cells that are lost as opposed to just trying to prevent damage.

MICHAEL BUCKLEY: We have one last question before we turn to some concluding remarks. A listener heard you mention the Apellis product that’s been developed. Do you have a sense of when that might be available for patients?

DR. DAVID LIAO: Clinical trials have to go through different phases. The first several phases are mainly for safety and also to find some efficacy. These larger trials that they’re going through now are really to establish the efficacy and, of course, to confirm the safety, as well. That trial is fully enrolled. They’re done with the number of patients that they were slated for, and so hopefully, we’ll have the results next year and perhaps even the approval next year if the results are good. So, I think within the next few years, we’ll have some new treatments out available for us.

MICHAEL BUCKLEY: That’s very encouraging. Dr. Liao, in the moments we have left, I was wondering if there are big-picture thoughts you’d like to leave us with? Is there something that you wish your patients knew more about or did more about or any sort of big-picture advice you can give to families that are impacted by AMD?

DR. DAVID LIAO: The main take-home point is that there really is hope for new treatments out there. The advances are coming every year. There are new treatments available both for prevention and for people that have already lost a significant amount of vision. We’re still a ways off, but we’re working toward that, and so I think this is a team approach between doctors and patients. So, we try to do as best we can from the research side, from the treatment side, and make everything available, but good follow-up and letting your doctor know if there are any changes, that’s part of it, too. And together, hopefully, we can reduce some of the disability that’s out there from the vision loss, and maybe in a year or two, we’ll have—or in a few more—we’ll have much more effective treatments out there. So, I think it’s good to stay hopeful and know that there are new treatments coming down the line.

MICHAEL BUCKLEY: That’s really encouraging advice to conclude the conversation with. Dr. Laio, on behalf of today’s listeners and the BrightFocus Foundation, I just want to thank you. I think you have given us a lot of good information and hope for the future, so I just want to say thank you for being so generous with your time today.

DR. DAVID LIAO: Thank you, Michael. It’s a real pleasure.

MICHAEL BUCKLEY: This concludes the BrightFocus Chat. Thank you very much for joining us today.


Useful Resources and Key Terms

BrightFocus Foundation: (800) 437-2423 or visit us at www.BrightFocus.org. Available resources include

Other resources mentioned during the Chat include—

  • AREDS2
  • Amsler grid
  • PreserVision, Ocuvite, or ICaps
  • ForeseeHome Monitoring System
This content was first posted on: August 26, 2020
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