Roya Attar, OD, MBA, DHA, director of optometric services at the department of ophthalmology at the University of Mississippi Medical Center, has adjusted her approach to working with patients with geographic atrophy (GA). The notable shift is directly related to the emergence of treatment options, which have altered both her vigilance and patient care strategies. “My awareness and proactiveness regarding GA have shifted significantly with the recent availability of treatment options,” she says. “Knowing that there is now a way to potentially slow the progression of GA has made me far more vigilant in looking for early signs of the disease.”
Key to this transformation is the use of advanced imaging techniques. “One of the key tools I’ve come to appreciate even more is fundus autofluorescence (FAF). It’s been invaluable in identifying areas of retinal atrophy and monitoring progression. However, optical coherence tomography (OCT) remains my go-to for identifying early biomarkers and structural changes in the retina,” she explains. These tools allow her to catch early signs, a critical factor in the long-term management of GA.
COMPREHENSIVE EXAMS
“During the initial visit, I perform a comprehensive eye exam that includes a detailed review of the patient’s history, paying special attention to risk factors such as age, genetics, lifestyle (e.g., smoking) and any signs of age-related macular degeneration (AMD). If patients present with drusen or other changes suggestive of early AMD, I’ll typically schedule them for further testing, which includes an OCT and fundus photography,” she says.
“If I notice signs of early atrophy on OCT or if the patient is considered at high risk based on their history, I also obtain an FAF. FAF is particularly useful for detecting areas of atrophy that may not yet be visible through OCT or fundus photos,” she adds.
The frequency of follow-up depends on the risk level. “For higher-risk patients or those with early signs of GA, I typically schedule follow-ups every three to six months. I repeat OCT and FAF imaging to track any changes in the retina. If I’m noting progression, I discuss treatment options with the patient.”
Early intervention with a complement inhibitor treatment may make a difference in slowing the progression of their disease.
While her office does not have the technology to test dark adaptation, she sees that it could be a valuable way to detect subclinical AMD, and in the future, genetic testing might be an option, too.
GIVING PATIENTS HOPE
“In the past, conversations about GA were often focused on managing expectations, as there were no viable treatments available,” she recalls. “Now, I’m able to offer hope in a way I couldn’t before. When I identify patients at risk for GA progression, I make sure to have a thorough discussion about their condition, the factors that put them at higher risk and the importance of regular monitoring.”
In her discussions with patients, Dr. Attar ensures they understand the risks and benefits associated with treatments. Because she is in the ophthalmology department at the medical center, “I get fairly in-depth with patients when discussing GA, the risks and treatments for advanced GA,” she says. By thoroughly explaining the available options, she helps them make informed decisions, empowering them to take control of their condition.
Collaboration with retina specialists plays a crucial role in Dr. Attar’s patient care philosophy. “I have close relationships with the retina specialists that I work with and refer to regarding their treatment philosophy for GA,” she says. These collaborations help her align management strategies with the latest clinical guidelines, ensuring a cohesive approach to patient care.
MONITORING FOR PROGRESSION
Monitoring for GA progression is an intricate process. “When monitoring for GA, I’m looking for early signs of retinal thinning and damage, particularly in the outer retinal layers and the retinal pigment epithelium (RPE) on OCT,” she explains. She also watches for specific biomarkers—subtle changes that can indicate how far the disease has progressed and whether intervention is necessary.
As an optometrist, Dr. Attar sees herself on the front lines of AMD and GA detection. “We are often the first point of contact for patients, allowing us to identify early signs of AMD and GA through comprehensive eye exams and advanced multimodal imaging techniques,” she says. This proactive approach allows her to intervene early, working hand-in-hand with retina specialists to improve patient outcomes.
Dr. Attar’s commitment to evolving technologies, patient education and interprofessional collaboration ensures that her patients are at the center of cutting-edge care.
Learn more at FindGAFirst.
