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Carolyn Majcher, OD, FAAO, says early detection of geographic atrophy (GA) is now both more possible and more critical than ever for preserving patients’ vision. Advances in multimodal imaging, especially higher-resolution, faster OCT, allow clinicians to detect subtle changes such as attenuation of the photoreceptors and early retinal pigment epithelial changes. These may have been previously missed. Dr. Majcher says these improvements let clinicians perform sophisticated serial analysis of OCT progression, overlay different imaging modalities and use emerging review software and AI applications to spot early disease.
For primary care optometrists, the implications are clear. Dr. Majcher, a professor and director of residencies at Northeastern State University College of Optometry, says the incidence of macular degeneration is rising. “Primary care optometrists should be able to manage early macular degeneration and catch early geographic atrophy,” she says. She emphasizes that OCT and fundus autofluorescence are straightforward tools for identifying GA. On fundus autofluorescence, one looks for well‑demarcated dark areas often surrounded by hyperfluorescence. On OCT, one looks for loss of the photoreceptors and a characteristic “sinkhole” or V-shaped subsidence where the retina thins. The essential practical step, she says, is to take the time to scroll through the entire OCT cube and identify those early areas of atrophy.
Listen to a podcast with Dr. Majcher here.
COUNSELING AND TREATMENT OPTIONS
Early detection matters because it changes what clinicians can offer patients. Dr. Majcher says clinicians should discuss behavioral, modifiable risk factors—including diet and smoking cessation—as part of efforts to decrease progression and to prevent conversion to neovascular disease. She says it is also important to explain new medical options: complement inhibition therapies now approved for GA are delivered as intravitreal injections. These are intended to slow progression rather than improve vision. “The natural prognosis of the disease is that it is progressive and irreversible,” Dr. Majcher says. “The longer we wait to treat, the more vision they’re going to lose. It’s unrecoverable.” She notes that extension study data makes a compelling case for early referral and treatment: earlier therapy preserves more retina compared with delayed treatment.
Imaging is also a powerful tool for patient education. Dr. Majcher says she uses imaging review software at the end of the exam to show how areas of atrophy have enlarged over time. These images help patients understand prognosis and the potential impact of early treatment.
She stresses that visual acuity alone is an inadequate monitor for GA. Patients can have severe non‑central GA and still read 20/20, so clinicians must use OCT, near‑infrared reflectance and fundus autofluorescence to track progression. She also points out that patients with early GA often report functional symptoms, such as slower reading speed, difficulty in dim light, trouble driving, even when their acuity remains good.
LEVERAGE THE TECHNOLOGY
Dr. Majcher says that most optometrists already have OCT in their offices or access to the technology. A higher use of imaging supports a shift toward medical eye care. She encourages clinicians to become proficient in multimodal imaging interpretation and to stay current with evolving treatments through conferences and online continuing education resources. She cites online venues and recorded retina programs as accessible ways to learn, and she offers that faculty and colleagues are available to consult on scans or patients.
Ultimately, Dr. Majcher says the goal is preservation of vision. By detecting GA earlier, educating patients about modifiable risks and treatment options, using imaging to monitor progression and referring promptly when appropriate, primary care optometrists can help maintain patients’ independence and quality of life. As a rural OD, whose patients often have to travel far to see a retina physician, her role as counselor and advocate is an important one. She calls this “an exciting time” because, unlike the past, clinicians now have therapies and strategies that can slow the course of GA when identified and acted on early.
This editorially independent content is sponsored by Astellas.
