Jessica Steen, OD, FAAO, of Nova Southeastern University College of Optometry and attending optometric physician at the college’s Eye Care Institute, says that careful evaluation of the retina, including the macula, is an integral part of a comprehensive eye exam. As director of the glaucoma service, she and other clinicians in this specialty practice often manage older individuals who are also at greater risk for macular diseases. Early detection is crucial for achieving the best possible outcomes. With diseases like glaucoma and geographic atrophy (GA), identifying the condition early allows for timely intervention, which can slow the progression and improve long-term management.
Since the introduction of two therapies for GA, there’s a new urgency. “Whenever there is a therapeutic option for a disease state where there hadn’t been one, it requires us to address our current practice and referral patterns. We previously discussed GA as a chronic ocular disease that we monitor and co-manage only with low-vision specialists. Now, in addition we have a therapeutic option that can meaningfully slow progression.”
DIAGNOSTIC TECHNOLOGY
At the same time, diagnostic technology such as optical coherence tomography (OCT) and fundus autofluorescence have revolutionized how eye care professionals (ECPs) detect and monitor diseases like GA and age-related macular degeneration (AMD). These tools allow for the identification of specific biomarkers that indicate disease presence and progression risk.
“OCT has changed the way we manage disease. In AMD, we are looking for biomarkers that are indicative of the risk of progression to GA like calcific drusen, subretinal drusenoid deposits and hyperreflective foci. In GA, we look for choroidal hyper-transmission with complete RPE and outer retinal atrophy. When we see choroidal hyper-transmission as bright areas of light passing into the choroid, it signals that the RPE is damaged or absent,” she says.
Fundus autofluorescence is another very valuable tool, she says. “A signal is created by lipofuscin in RPE cells, which is a byproduct of photoreceptor metabolism. When there is pathology and those RPE cells are sick or stressed, lipofuscin accumulates, so it creates a very strong bright signal, hyperfluorescence. In GA, due to the absence of RPE cells and therefore absence of lipofuscin, hypofluorescence is observed.”
“The early identification and management of any ocular disease process is the aim of optometry. We are experienced in the diagnosis and management of chronic ocular diseases, and the interpretation and application of functional and structural testing. So there certainly is room for the diagnosis and early discussion of GA in a comprehensive eye care practice,” she says.
PATIENT COMMUNICATIONS
While it may be a different conversation with patients than in previous years, it’s still a particularly important one. “For patients who have a chronic ocular condition, like glaucoma, there are so many parallels to GA. The goal of treatment is not to cure the disease or reverse damage or even halt disease progression – It’s about slowing the disease progression in an individualized and meaningful way,” she says.
Dr. Steen starts with the recognition of GA. “What I see as my role is to diagnose the disease process and discuss the potential treatment options. It’s day one of a conversation that is ongoing. The patient can opt not to be referred, but each patient should know what options exist.”
In a clear and empathetic way, she also emphasizes the importance of adherence to prescribed therapies. She wants to build a trusting relationship with patients.
MULTIDISCIPLINARY COORDINATION
Bringing in retinal specialists is, of course, central to treatment for these patients. “It’s important to know that your referrals will be appropriate. Ask what therapies retinal specialists are using and what their criteria are for therapy are,” she suggests.
Don’t overlook cross-optometric referrals, Dr. Steen says. “If you’re managing retinal and optic nerve health, it is probably necessary to have an OCT. But not every OD has that, so let other ODs in the area know that you have the technology and experience in working with patients for this aspect of their care.”
Optometrists who are managing care for their glaucoma patients may already be familiar with the parallels between glaucoma and GA. “Both underscore the importance of early detection, clear patient communication and multidisciplinary collaboration. Advances in diagnostic technology and therapeutic options enhance our ability to manage these chronic conditions effectively, aligning with the mission of optometry to provide high-quality eye health care,” she says.
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.
