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Photodynamic Therapy for Retinal Conditions
Conditions Treated With PDT
PDT is used to treat several retinal conditions involving abnormal or leaking blood vessels beneath the retina. A retina specialist will evaluate your specific diagnosis, imaging results, and overall eye health before recommending PDT or any other treatment approach.
Wet AMD occurs when abnormal blood vessels grow beneath the macula, the central portion of the retina responsible for sharp, detailed vision. These vessels can leak fluid or blood and cause rapid central vision loss. PDT is an established treatment option for certain patterns of wet AMD, particularly when abnormal vessels are located directly beneath the center of vision or when anti-VEGF injections alone have not produced an adequate response.
Central serous chorioretinopathy, known as CSC, is a condition in which fluid accumulates beneath the central retina. The chronic form of CSC, when fluid persists for several months or keeps returning, is one of the most common current uses for PDT. Research has shown that PDT, particularly a modified lower-dose approach, is widely considered a first-line treatment for chronic CSC. Approximately 80 percent of chronic CSC patients achieve complete resolution of fluid after a single PDT session in clinical studies.
PDT is also used for abnormal blood vessel growth caused by pathologic myopia (severe nearsightedness) and ocular histoplasmosis syndrome, a fungal infection that can affect the eye. In these cases, verteporfin is FDA-approved when abnormal vessels are located in the central portion of the retina. A retina specialist will determine whether PDT is appropriate based on the location, size, and type of abnormal vessels seen on imaging.
Diagnosis and Imaging Before PDT
Before recommending PDT, our retina specialists perform detailed imaging to map the abnormal blood vessels precisely. Accurate pre-treatment imaging is essential for determining whether PDT is appropriate, where to aim the laser, and how to measure the response to treatment afterward.
Fluorescein angiography involves injecting a yellow dye into a vein in the arm. As the dye circulates through the blood vessels in the retina, a specialized camera takes rapid photographs. The images reveal the exact location, size, and pattern of abnormal blood vessels. This information helps identify which type of abnormal vessel growth is present and whether PDT is likely to be effective.
Indocyanine green angiography, or ICG, uses a different dye that highlights the deeper blood vessel layers beneath the retina, an area called the choroid. ICG imaging is particularly useful for evaluating CSC and identifying abnormal vessels that may not appear clearly on standard fluorescein angiography. This test helps our specialists map the precise area that needs to be treated with the PDT laser.
Optical coherence tomography, known as OCT, is a noninvasive scan that produces detailed cross-sectional images of the retinal layers. OCT clearly shows fluid buildup, swelling, and structural damage within the retina. Our team uses OCT both before PDT to assess the extent of the problem and after treatment to monitor whether fluid has resolved. OCT angiography, an advanced form of this imaging, can visualize blood vessel flow without the need for an injected dye.
PDT Treatment Approaches
The way PDT is used depends on the specific condition being treated, the severity of the disease, and how the eye has responded to prior treatments. Our retina specialists tailor each treatment plan to the individual patient based on clinical findings and imaging results.
For patients with wet AMD, anti-VEGF injections (medications that block the protein driving abnormal blood vessel growth) have become the standard first-line treatment because they produce better visual outcomes for most patients. Anti-VEGF options in this class include Avastin, Lucentis, Eylea, and Vabysmo. PDT for wet AMD is generally used today for patients whose condition has not responded adequately to anti-VEGF therapy alone, or in cases where the pattern of abnormal vessels makes PDT a better fit.
For chronic central serous chorioretinopathy, PDT has become a well-established primary treatment. Many retina specialists use a modified approach called half-dose PDT, in which the amount of verteporfin is reduced to lower the risk of side effects while still effectively closing the source of fluid leakage. Clinical studies have found that patients with worse baseline vision experienced the greatest improvement, with a meaningful percentage gaining two or more lines of visual acuity after a single PDT session.
In some cases, a retina specialist may recommend combining PDT with anti-VEGF injections. This combination approach works through two different mechanisms at the same time: PDT physically closes abnormal vessels through a photochemical reaction, while anti-VEGF medications block the growth signals that drive new abnormal vessel formation. For certain patients with wet AMD, combining these treatments may help maintain effectiveness while reducing the total number of injections needed over time.
What to Expect During Your PDT Procedure
PDT is performed in the office and is generally well tolerated. Knowing what happens at each stage of the procedure helps reduce anxiety and allows you to prepare properly for the days following treatment.
Before the procedure, our team will perform a thorough eye examination and review your imaging. Let your retina specialist know about all medications you are taking, especially any that may increase sensitivity to light. Arrange for someone to drive you home, as your vision may be slightly blurry after the procedure. You will also need dark sunglasses and protective, sun-covering clothing ready to wear as soon as you leave the office.
The entire PDT session typically takes about 20 to 30 minutes. A nurse or technician places an intravenous line in the arm and infuses verteporfin over approximately 10 minutes. After a brief waiting period for the drug to collect in the abnormal blood vessels, the retina specialist applies the low-energy activating laser to the targeted area for approximately 83 seconds. The laser is painless, and patients remain seated at a specialized instrument similar to what is used during a routine eye examination.
After PDT, verteporfin remains active in the body and makes the skin and eyes highly sensitive to light for five days. Exposure to direct sunlight or intense indoor lighting during this period can cause severe sunburn-like reactions on any exposed skin and may cause additional eye damage. Patients who need to go outdoors should wear long sleeves, gloves, a wide-brimmed hat, and wraparound dark sunglasses that block light from all angles. Normal low-level indoor lighting from household lamps is generally considered safe.
Our team will schedule follow-up visits to monitor your response using OCT imaging and, in some cases, repeat angiography. Because the effects of PDT can be temporary, with some abnormal vessels reopening over time, additional treatments may be needed. For wet AMD patients, ongoing anti-VEGF injections are often continued alongside PDT. Many patients with chronic CSC achieve lasting results after a single session, though retreatment is sometimes necessary.
Risks, Side Effects, and Long-Term Management
PDT is generally safe and well tolerated, but like all medical procedures it carries potential risks. Our specialists will discuss these risks with you before treatment and help you plan for a smooth recovery.
The most important precaution is photosensitivity in the five days following treatment. Failing to avoid bright light during this period can result in serious skin reactions on exposed areas. In rare cases, verteporfin can cause temporary swelling in the eye that briefly reduces vision. Other less common side effects include mild back pain during the drug infusion, temporary visual disturbances, and reactions at the injection site. Your retina specialist will review all potential risks before scheduling your procedure.
PDT is designed to slow or stop ongoing vision loss and, in many cases, to improve vision by resolving fluid or closing leaking vessels. It does not restore vision that has already been lost due to long-standing retinal damage. For patients with wet AMD, the primary goal is preserving as much central vision as possible. For patients with chronic CSC, resolution of fluid often leads to noticeable improvement in clarity and reduced image distortion, though some subtle visual differences may remain.
Patients undergoing PDT should plan their work and personal schedules around the five-day light-avoidance period. Using an Amsler grid, a simple printed chart used at home to detect changes in central vision, can help you notice new distortion or blank spots between appointments. A diet rich in leafy green vegetables and omega-3 fatty acids, not smoking, and managing blood pressure all support long-term retinal health.
Warning Signs That Need Immediate Attention
Some vision changes are medical emergencies and should never be monitored at home. Knowing which symptoms require urgent care could make a critical difference in protecting your sight.
Contact a retina specialist immediately or go to an emergency room if you experience any of the following symptoms, as they may indicate a retinal tear, detachment, or other serious event requiring prompt treatment.
- A sudden large increase in floaters (dark spots, strands, or webs drifting through your vision)
- Flashes of light in one or both eyes
- A curtain, shadow, or dark area spreading across your field of vision
- Sudden loss of vision in one or both eyes
Even when your vision seems stable, regular follow-up appointments are essential after PDT. Conditions like wet AMD and chronic CSC can recur without obvious symptoms at first, and early detection allows for timely adjustment of your treatment plan. Our team uses serial retinal imaging at every visit to track changes over time, giving us a documented record of how your retina responds between appointments. Report any new or worsening visual symptoms promptly rather than waiting for your next scheduled visit.
Frequently Asked Questions
Below are answers to questions our patients most commonly ask about photodynamic therapy. These answers are meant to add practical guidance beyond what is covered in the sections above.
The laser itself does not cause pain. The infusion of verteporfin feels similar to a standard blood draw, and some patients notice mild back discomfort during the infusion that typically resolves within minutes. Most patients complete the procedure comfortably without the need for sedation. Standard numbing eye drops are used, and the laser portion lasts less than two minutes.
The choice between PDT, anti-VEGF injections, or a combination of both depends on your specific diagnosis, the type and location of abnormal blood vessels identified on imaging, and how your eye has responded to prior treatment. For wet AMD, anti-VEGF injections are typically recommended first, with PDT considered for cases that do not respond adequately. For chronic CSC, PDT is often the preferred approach because anti-VEGF medications have shown limited effectiveness for that condition. Your retina specialist will review your imaging findings and walk you through the reasoning behind the recommended plan.
Many patients with indoor desk jobs can return to work the following day. The critical restriction for all patients is avoiding direct sunlight and intense light sources for five full days after treatment. If your job requires outdoor exposure, extended time under bright overhead lighting, or work in sunlit environments, you may need to take time off or make temporary modifications. Discuss your specific work situation with your retina specialist before scheduling the procedure so you can plan accordingly.
If you are accidentally exposed to sunlight or intense light within five days of treatment, move indoors or into shade immediately and cover any exposed skin. Contact your retina specialist as soon as possible to report what happened and receive guidance. The reaction can range from mild redness to a significant sunburn-like injury depending on the duration and intensity of exposure. The best prevention is thorough preparation before leaving the clinic: wear wraparound sunglasses, gloves, long sleeves, and a wide-brimmed hat any time you need to go outdoors during the five-day window.
The durability of PDT varies by condition and by individual. For chronic CSC, many patients achieve long-lasting resolution after a single session, though a smaller percentage require retreatment if fluid returns. For wet AMD, abnormal vessels may reopen over time, and ongoing monitoring is essential to detect any recurrence early. Your retina specialist will use repeat OCT imaging at follow-up visits to assess whether the treatment has held and whether additional intervention is needed. Having a clear retreatment plan in place from the start can help reduce concern if recurrence does occur.
Retinal Care on the Delmarva Peninsula
Atlantic Retina Center is a single-specialty vitreoretinal practice dedicated exclusively to the health of the retina, vitreous, and macula. Our team of fellowship-trained, board-certified retina specialists brings deep expertise in PDT and the full range of retinal treatments to patients across the Eastern Shore of Maryland and central and southern Delaware. If you have been diagnosed with a retinal condition or are experiencing changes in your vision, we encourage you to schedule an appointment so our team can evaluate your eyes and help you understand your options.