Jessica Haynes, OD, of the Charles Retina Institute in Germantown, Tennessee, explains why early detection and timely referral of geographic atrophy (GA) are critical. With innovations in treatment, the outlook for patients living with GA continues to improve.
“Unfortunately, we sometimes get patients referred in really advanced stages,” Dr. Haynes says. “Some haven’t even been told they have macular degeneration before—they just didn’t realize their eyes could change so quickly.” Even patients who see an eye care professional (ECPs) every year can develop new vision-threatening damage between visits, she notes.
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Dr. Haynes stresses that primary ECPs play a decisive role in early intervention. “First, the patient has to get a diagnosis,” she says. “Everything starts at that point.”
Once AMD is identified, accurate staging determines the next steps. Early disease is characterized by a handful of small or medium drusen, while intermediate disease features large drusen or pigmentary changes. Before referring, clinicians must carefully rule out advanced disease—either GA or wet AMD—using modern imaging tools. “Anyone who has an OCT at this point should be able to fairly easily identify GA,” she notes.
When to refer is a nuanced decision. “There’s no harm in referring a GA patient to a retina specialist,” Dr. Haynes says, especially now that treatment options exist. Yet in some regions, local specialists may not routinely treat GA, making it all the more important for primary ECPs to understand referral patterns. “It can be tricky if you know your retinal specialist is not going to treat GA,” she acknowledges, but there is still value in starting the conversation with patients.
GOAL IS TO PRESERVE VISION
Treatment for GA remains challenging. Unlike exudative AMD—where patients notice vision improvement after anti-VEGF injections—GA therapies aim to slow further damage rather than restore lost vision. “It can be a lengthy conversation,” Dr. Haynes admits. “Patients who benefit the most are often those with good vision; you’re trying to preserve what they still have.” But because they have no or few symptoms, it can be difficult to motivate them to pursue treatment. Educating patients about the gradual nature of treatment and managing expectations are critical parts of that process. For patients who have watched a family member lose vision due to the disease progression, the message can resonate more quickly.
Now, more than two years into offering complement inhibitor therapy, the doctors are seeing the positive trend. “I can tell them, ‘I think you are better off today than you would have been had you not done this two years ago.’”
“More hope exists today than ever before for GA patients,” she says. “Even if treatment options change in the future, the most important thing is that providers identify GA and begin the conversation early. That gives patients the best chance to preserve vision—because everything starts with recognizing the disease is there.”
This editorially independent content is sponsored by Astellas.
