Vision Expo 2026: How optometry's approach to AMD and diabetic retinopathy has transformed with Dr. Mary Beth Yackey

Drawing from more than 2 decades in clinical practice, Mary Beth Yackey, OD, of the Cincinnati Eye Institute, used her presentations at Vision Expo 2026—held March 11-14, in Orlando, Florida—to outline how dramatically the management of age-related macular degeneration (AMD) and diabetic retinopathy has shifted and what those shifts demand of optometrists today. Her sessions, "Summit: Early Intervention Strategies for Dry AMD & Presbyopia" and "Diagnosis Diabetes: The Optometric Management Guide," together made a compelling case that optometry's role as the front line of retinal disease care has never been more consequential or more complex.

The transformation in AMD management is perhaps the most striking. For years, the dry-to-wet AMD continuum offered clinicians a relatively passive early-stage approach: monitor, counsel, and wait for conversion to neovascular disease before escalating to the retinal specialist. That paradigm has been dismantled by a wave of new therapeutic options: the 2023 FDA approvals of pegcetacoplan (Syfovre; Apellis Pharmaceuticals) and avacincaptad pegol (Izervay; Astellas Pharma) as the first-ever treatments for geographic atrophy (GA) fundamentally altered the calculus around referral timing.^1,2 Where clinicians once waited for wet conversion to send patients to a retina specialist, Yackey argues that the availability of both GA-directed pharmacotherapy and photobiomodulation at some retinal practices now warrants earlier referral for dry AMD patients than was previously the norm. The goal is to intervene before atrophic lesions encroach on central vision—because by the time central acuity is affected, critical tissue has already been lost.

Just as consequential as the new treatment options, Yackey contends, is what happens before a patient ever develops AMD. Smoking remains the single most important modifiable risk factor for the disease, a finding supported by extensive epidemiological evidence. A systematic review published in Eye found that current smokers face a 2- to 3-fold increased risk of AMD compared with never-smokers, with evidence of a dose-response relationship.³ More recent meta-analytic data have placed the risk even higher, with current smokers estimated to be 7 to 12 times more likely to develop AMD than nonsmokers.⁴ Yackey draws on her own clinical experience across multiple practice locations to illustrate this point vividly: her patient populations in areas with higher smoking rates carry markedly higher rates of macular degeneration than those in communities where smoking is less prevalent. Her message to optometrists is direct—read your patient population, have the smoking cessation conversation early and often, and understand that early intervention for AMD may begin not with a prescription or a referral, but with a frank discussion about tobacco use and family history.

Taken together, Yackey's presentations at Vision Expo 2026 underscore a fundamental truth about the current moment in retinal disease management: the tools available to clinicians—both for early detection and for treatment—have advanced faster than many practice patterns have adapted. For optometrists willing to stay current, to counsel patients early, and to refer strategically rather than reactively, the opportunity to meaningfully alter the long-term visual trajectories of patients with AMD and diabetic retinopathy has never been greater.

REFERENCES

1. Liao DS, Grossi FV, El Mehdi D, et al. Complement C3 inhibitor pegcetacoplan for geographic atrophy secondary to age-related macular degeneration: a randomized phase 2 trial. Ophthalmology. 2020;127(2):186-195. doi:10.1016/j.ophtha.2019.07.011.

2. Khanani AM, Patel SS, Staurenghi G, et al. Efficacy and safety of avacincaptad pegol in patients with geographic atrophy (GATHER2): 12-month results from a randomised, double-masked, phase 3 trial. Lancet. 2023;402(10411):1449-1458. doi:10.1016/S0140-6736(23)01583-0.

3. Khan JC, Thurlby DA, Shahid H, et al. Smoking and age related macular degeneration: the number of pack years of cigarette smoking is a major determinant of risk for both geographic atrophy and choroidal neovascularisation. Eye. 2006;20(1):75-80. doi:10.1038/sj.eye.6701778.

4. Chua SYL, Warwick AN, Peto T, et al. Impact of smoking on ocular health: a systematic review and meta-meta-analysis. Br J Ophthalmol. Published online 2025. doi:10.1136/bjo-2024-326357.