Diabetes-related retinal disease (DRD) and geographic atrophy (GA) represent two significant threats to vision, and their prevalence is steadily increasing, says Sherrol Reynolds, OD, FAAO. Dr. Reynolds is a professor at Nova Southeastern University College of Optometry, where she counsels students and her colleagues that these conditions demand attention not only because of their impact but because of the commonalities in detection, monitoring and education.
“Diabetic retinal disease (DRD) is the leading cause of blindness in working-age individuals aged 18 to 74, while age-related macular degeneration (AMD) is the primary cause of vision loss in those over 55,” Dr. Reynolds explains. Emerging research highlights a potential link between diabetes, DRD and GA, an advanced form of dry AMD. Although the exact mechanisms remain unclear, shared risk factors such as aging, smoking, hypertension, hyperlipidemia, obesity and lifestyle factors underscore the importance of early detection and patient education.
THREE ACTIONS FOR ODs
While many ODs feel confident in detecting and managing patients with DRD, these approaches can and should apply to the management of patients with GA as well. Dr. Reynolds emphasizes three critical steps optometrists can take to support patients at risk for or living with GA. With increased prevalence and more options for intervention, it becomes increasingly important that primary care optometrists are confident and comfortable in taking at least these three steps, she says. “We can slow down the progression of the disease now.”
Patient Education and Lifestyle Modifications
Raising awareness is the first step. Patients need to understand the shared risk factors between DRD and GA, such as smoking, poor diet and obesity. Encouraging lifestyle changes, including smoking cessation (e-cigarette or vaping), adopting a healthy diet and managing weight can significantly reduce progression risks. “Education is crucial,” Dr. Reynolds stresses. “Helping patients recognize the impact of their choices empowers them to take preventive action.”
Early Detection Through Advanced Imaging
Advanced diagnostic tools are essential in identifying early signs of both DRD and GA. Techniques such as widefield retinal imaging and fundus autofluorescence (AF) can help establish a baseline and serve as an important patient education tool, she says. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA)can detect subclinical changes and biomarkers before symptoms manifest. For example, drusen, which can be seen on both color fundus photography and OCT, are hallmarks of early AMD,
“Showing patients their retinal images can help them visualize the condition and understand its progression,” Dr. Reynolds notes. Documenting these findings establishes a baseline, which is vital for monitoring disease progression and determining treatment effectiveness.
Provide patients with home monitoring tools like a take-home Amsler grid. For both DRD and GA, monitoring for visual changes from macular edema or central vision loss can mean faster referral and possible intervention.
Comprehensive Eye Exams and Timely Referrals
Optometrists are already providing comprehensive eye exams and many are talking about lifestyle and other risk factors to ocular and overall health. So incorporating discussions on DRD and GA can be folded in. Dr. Reynolds advises that patients with or at risk for DRD or GA be seen annually, or more frequently if signs of retinal changes are observed.
“Timely referral to a retina specialist is crucial,” she says. With two new intravitreal drugs— avacincaptad pegol (Izervay) and pegcetacoplan (Syfovre)—offering hope for GA patients, early intervention can stabilize vision and slow disease progression. “These treatments don’t reverse the damage, but they can help patients maintain functional vision for longer.” If treatment starts while the patient still has relatively good vision, for example 20/40 vision, that patient may be able to retain that visual acuity for longer.
HOPE FOR PATIENTS
Not every patient is going to choose to be treated, notes Dr. Reynolds. But all patients who are at risk for GA should be made aware that there are options now that could slow down the progression. “We have hope now. I tell my students that today we can offer our patients with GA hope. While there’s no cure, stabilizing vision is achievable.”
Optometrists must remain vigilant, especially as the number of patients with these conditions continues to grow. Worldwide, 8 million are affected by GA, with 1.5 million cases of some stage of GA in the U.S. alone and 10 million people have some form of DRD. By prioritizing education, leveraging advanced diagnostics and ensuring timely referrals, eye care providers can make a significant difference in preserving vision and improving patients’ quality of life.
“We’re entering a new era of care,” Dr. Reynolds concludes. “It’s about prevention, early detection and offering patients the hope of stability.”
LEARN MORE
Visit findgafirst.com for diagnostic hallmarks of AMD, guides to managing patients with GA and resources for your office.
Read other stories about how ODs are detecting and talking with patients about GA here.
This content is independent editorial sponsored by Astellas. Astellas had no input in the development of this content. Astellas, formerly Iveric Bio.