Vision Expo 2026: OCT and OCTA real-world case studies of AMD

During Vision Expo 2026 in Orlando, Florida, Carolyn Majcher, OD, FAAO, discussed the rapidly evolving and increasingly optimistic landscape of age-related macular degeneration (AMD) management, emphasizing that AMD is now a relatively manageable disease compared to the past. A key turning point highlighted is the FDA approval of complement inhibitors for geographic atrophy around 2023, which for the first time provided a treatment option for this previously untreatable advanced dry AMD stage. Building on that, the field is shifting even earlier in the disease course, exploring interventions in intermediate AMD. One example given is photobiomodulation or low-level light therapy, aimed at slowing progression so patients ideally never reach advanced AMD.

Majcher stressed that the primary role of eye care providers is to detect treatable features of AMD as early as possible. This includes identifying conversion to wet (exudative, neovascular) AMD and recognizing the earliest signs of geographic atrophy. Early detection and treatment, whether for neovascular AMD or geographic atrophy, are linked to better visual outcomes. To achieve this, the speaker underscores the importance of both in-office and home monitoring.

In-office, multimodal imaging is considered critical. Optical coherence tomography (OCT) is described as the standard of care, with OCT angiography, fundus autofluorescence, and fluorescein angiography serving as valuable adjuncts. Monitoring frequency is tailored to disease severity: for high-risk intermediate AMD, follow-up every three months is typical, while early AMD may be seen annually, adjusted for individual circumstances. Home monitoring tools, such as ForeseeHome, are promoted as superior to simple Amsler grid testing because they continuously track visual function and upload data to the cloud, alerting clinicians to changes so patients can be recalled promptly.

A clinical case underscores these principles: the grandmother of a student presented after 12 injections in one “bad” eye and came in questioning whether to proceed with a 13th injection. That eye had very poor vision and substantial subretinal fibrosis. The other “good” eye, with vision around 20/40, appeared clinically to have only dry intermediate AMD. However, OCT revealed a small amount of intraretinal fluid and a tiny pigment epithelial detachment; OCT angiography then confirmed early neovascularization. Majcher emphasized that without OCT and OCT angiography, this eye might have been misdiagnosed as purely dry AMD, potentially leading to severe, preventable vision loss in the better-seeing eye. This illustrates how advanced imaging shifts the clinical focus from simply treating the damaged eye to preserving the good eye.

Majcher also addressed practical barriers to OCT angiography adoption. Although a CPT code now allows reimbursement for this procedure, there is a significant up-front equipment cost because it requires a newer OCT with motion tracking. Additionally, there is a steep learning curve: unlike modalities with simple red/yellow/green outputs, OCT and OCT angiography require detailed understanding of retinal anatomy and pathology, and there is no normative database that interprets the images for the clinician. Proficiency comes from regular use, and “if you don’t use it, you lose it” applies.

Lastly, Majcher noted that optometry schools do a solid job educating students in OCT, OCT angiography, and medical optometry. However, many graduates enter practice settings focused primarily on refractions and are pressed for time, causing their imaging skills to atrophy. Some later return to continuing education courses after purchasing their first OCT, needing to relearn interpretation. This illustrates the gap between educational preparation and real-world utilization, reinforcing the message that early, consistent use of advanced imaging is crucial for optimal AMD care.