AAOpt 2024: Early detection and thorough imaging are the key to vision preservation in geographic atrophy

At the 2024 American Academy of Optometry meeting in Indianapolis, Indiana, Carolyn Majcher, OD, FAAO, describes optometrists' crucial role in the early identification and management of geographic atrophy (GA), an advanced form of age-related macular degeneration (AMD). Recent advancements in treatment, coupled with the importance of timely intervention, make it imperative that we equip ourselves with the necessary knowledge and tools to detect GA in its earliest stages. In a collaborative discussion with Steven Ferrucci, OD, FAAO, Majcher, a professor and director of residency programs at the Oklahoma College of Optometry, highlighted the significance of early detection and referral for patients with GA.

Majcher emphasized that the newly approved intravitreal complement inhibitors, while not restorative, can effectively slow the progression of the disease, allowing patients to maintain their vision and quality of life for longer. The key, as Majcher explained, is to identify high-risk patients and initiate a comprehensive imaging protocol. Patients with large-sized drusen and pigmentary changes are at an increased risk of developing late-stage AMD, including GA. By utilizing multimodal imaging techniques, such as optical coherence tomography (OCT), fundus autofluorescence, and near-infrared reflectance, we can detect the early signs of GA before it invades the central fovea and significantly impacts vision. Majcher stressed the importance of not waiting for GA to progress to the point of visual impairment before referring patients to a retina specialist.

Patients with extrafoveal or non-centered GA, typically at least one disc area in size, are ideal candidates for the newly approved intravitreal complement inhibitor therapies. These treatments, while not restorative, can slow the progression of the disease, preserving precious visual function and improving the patient's quality of life.

Equally crucial is the need for patient education and setting realistic expectations. Patients must understand that the goal of these therapies is to slow the progression of GA, not to improve their vision. By managing their expectations and emphasizing the importance of regular monitoring and treatment, we can empower patients to be active participants in their care. As primary eye care providers, we have a responsibility to stay informed about the latest advancements in the management of GA. By mastering the techniques for early detection and establishing strong referral pathways, we can ensure that our patients with GA receive the timely and appropriate care they deserve, ultimately preserving their vision and enhancing their overall well-being.