Emerging evidence around MacuMira is prompting ophthalmologists to encourage optometrists to refer select dry AMD patients, with early clinical experience suggesting modest functional vision gains.
When one of Dr Shanel Sharma’s patients underwent treatment for advanced dry age-related macular degeneration (AMD), the most telling feedback didn’t come from the patient himself, but from his son.
“His son desperately requested, ‘There’s got to be something we can do for my dad. He calls me every day saying his life is terrible and he can’t see,’” Dr Sharma recalls.
After completing a course of MacuMira treatment, his son noted that the calls from his dad had stopped.
“His son said, ‘That MacuMira treatment you gave my dad must have helped as dad has stopped ringing me. Whatever this treatment did, it made dad feel there was an improvement to his life.”
For Dr Sharma, an ophthalmologist based in Bondi Junction and Miranda, Sydney, the experience reflects a subtle but important shift in how some patients with dry AMD are now being managed – and where optometrists may play a crucial and active role in referral.
Supporting the rollout of MacuMira in Australia is Nicola Bennett, who is involved in clinician education and support through Keeler, a UK-based manufacturer of ophthalmic equipment. Working alongside the technology’s developers and local distributor ParagonCare, Keeler is helping introduce the treatment to Australian clinicians, with a focus on training, clinical governance and ensuring it is integrated appropriately into existing care pathways.
MacuMira itself is a non-invasive, drug-free treatment that uses low-level microcurrent stimulation delivered via a headset over closed eyes. The aim is to stimulate retinal cell metabolism – particularly within the retinal pigment epithelium – supporting mitochondrial activity and cellular energy production. In doing so, it seeks to enhance the function of remaining viable cells in the macula.
That distinction is central to how both clinicians and industry are positioning the technology.
“It helps patients with everyday visual challenges by offering potential improvements in visual function and contrast sensitivity,” Bennett says.
A new referral consideration
Historically, optometrists have had limited reason to refer patients with dry AMD and reduced vision to ophthalmology, particularly in advanced stages where treatment options were scarce. Monitoring, lifestyle advice and low vision support have largely defined the pathway.
“That’s probably the biggest issue,” Dr Sharma says. “There are patients who are good candidates who aren’t being referred, because in the past there was no point – we couldn’t do anything.”
The emergence of MacuMira is beginning to challenge that long-standing assumption. While it is not a cure and is not indicated to slow the progression of geographic atrophy (GA), it introduces a different therapeutic objective: a potential functional improvement.
“This is a potential treatment to improve their vision,” Dr Sharma says. “So those patients, particularly with reduced vision, are worth referring.”
“For patients who are already struggling, even a one-line improvement can make a difference,” she says. “That might mean keeping a driver’s licence, reading more comfortably, or returning to activities like playing bridge.”
Bennett echoes the importance of identifying the right patient cohort, noting that those experiencing real-world visual challenges are most likely to perceive benefit.
“Suitable candidates are typically those with dry AMD across early through to late stages, provided there is no central geographic atrophy,” she says. “These patients often have measurable reductions in visual acuity and contrast sensitivity, and that’s where timely referral becomes important.”
She adds that patient selection should also take into account contraindications, including pacemakers, cochlear implants and epilepsy, as well as a broader clinical assessment aligned with the device’s instructions for use. For optometrists, this represents a shift in mindset: from a largely observational approach in certain dry AMD cohorts to one that includes referral as a viable option – even if treatment is not ultimately pursued.
Early experience and emerging evidence
Dr Sharma has been using MacuMira in her clinic since January 2026 and, while her experience remains limited, she describes the early outcomes as encouraging.
“We’ve treated three patients so far, and all have had at least a one-line improvement in visual acuity,” she says. “In two cases, it’s been the difference between being legally able to drive and not.”
One patient improved from 6/24 to 6/18, while another improved from 6/15 to 6/9. A third patient, with more advanced vision loss, experienced a measurable improvement on testing, but without a corresponding functional change in daily life.
“That’s where I think patient selection becomes important,” Dr Sharma says. “If vision is already very reduced, a one-line improvement may not translate into meaningful change.”
Her observations align with emerging international data. Bennett notes that while the technology is relatively new to Australia, it has been in clinical use in Canada for the past two years.
“Clinical study data indicates that patients in the treatment group achieved an average improvement of more than eight letters,” she says. “That’s supported by real-world experience, with more than 20,000 treatments delivered to over 4,000 patients across around 200 clinical sites.”
Even so, both emphasise that the evidence base is still developing, particularly in the Australian context.
“It’s still early days,” Dr Sharma says. “I don’t know how long the effect lasts, and I’m still building confidence in who the best candidates are.”
That uncertainty is not unusual for emerging technologies, but it does place greater emphasis on clinician judgement and careful patient counselling.
“I’m still cautious,” she adds. “I’m not at the point where I can say to every suitable patient, ‘You should definitely do this.’ But for some, particularly those who feel they have nothing to lose, it’s an option they’re willing to explore.”
Integrating into practice
MacuMira is delivered as a series of four treatments over approximately 10 days. The non-invasive nature of the therapy distinguishes it from intravitreal injections and other procedural interventions commonly used in retinal care.
Its mechanism, however, also sets it apart from emerging pharmacological treatments for dry AMD, such as complement inhibitors designed to slow the progression of geographic atrophy but not specifically to improve visual function.
“I warn patients that we don’t believe it can slow geographic atrophy,” Dr Sharma says. “It’s trying to get the cells that are still there to work better.”
This positions the treatment as complementary rather than competitive within the broader AMD landscape. Patients with established vision loss who are seeking functional improvement may be considered, whereas those focused on slowing disease progression may pursue alternative options.
For Bennett, this reinforces the importance of education as part of the rollout.
“It represents a supportive, non-invasive option for a clearly defined patient group,” she says. “The value lies in appropriate patient selection, realistic expectations, and integration into existing care pathways.”
To support this, Keeler and its partners are delivering structured education programs for both ophthalmologists and optometrists. These include clinical training, product education and ongoing support, aimed at helping practitioners understand where the technology fits and how to incorporate it into practice responsibly.
Bennett says this extends beyond initial training to on-the-ground engagement with clinics as they begin offering the treatment.
“My priority is spending time with clinicians, understanding how they’re using it in practice, and supporting initiatives like patient information evenings,” she says. “Those interactions are important for building confidence and embedding it effectively into care pathways.”
Barriers, expectations and next steps
Despite growing interest, several factors are likely to influence how quickly MacuMira is adopted and how widely referral pathways evolve.
Cost is a key consideration. The treatment is not currently subsidised under the Pharmaceutical Benefits Scheme (PBS), and patients typically require four sessions, resulting in a significant out-of-pocket expense.
“At the moment, because it’s not PBS subsidised, it’s not a treatment that’s readily available to everyone,”
Dr Sharma says. “It’s something patients need to weigh up carefully.”
Equally important is expectation management.
“I don’t want to be giving patients false hope,” she says. “Patients need to understand that patient outcomes may vary – but the evidence from a relatively small study indicates that in many patients it will help a bit.”
This balance between optimism and caution is echoed by Bennett, who says clear communication is central to responsible uptake.
“It’s about helping clinicians set realistic expectations around functional outcomes,” she says. “Not every patient will respond, and the goal is modest improvement rather than dramatic change.”
Across Australia, MacuMira is currently being introduced at a small number of sites, with clinicians informally sharing their experiences as local knowledge builds. At the same time, efforts are underway to expand the evidence base and refine patient selection criteria.
For optometrists, the immediate implication is straightforward, even if the long-term role of the technology continues to evolve.
“The key message is that these patients are worth referring,” Dr Sharma says. “Especially those with reduced vision in that mid-range.”
She is quick to emphasise that referral does not equate to treatment.
“Not every patient optometrists refer will go on to have it. We assess each case and talk through the options with the patient.”
As more data emerges and clinical experience grows, referral patterns may continue to shift. For now, Dr Sharma sees MacuMira as an additional pathway – one that may offer select patients a chance at small but meaningful gains.
“For the right patient,” she says, “even a small improvement in vision can make a real difference to their quality of life.”
Want more information?
For Australian and New Zealand ophthalmology practices seeking further information about MacuMira,
ParagonCare is the authorised distributor and provides local support, training and implementation guidance. Email vision@paragoncare.com.au.
