John W. Kitchens, MD: We’re all familiar with the data surrounding the two FDA-approved treatments for GA. But the art of medicine rests in figuring out how to apply those data to the real-world. With that in mind, which patients are best suited for complement inhibition therapy?
Geeta Lalwani, MD: Patient buy-in is key. Patients with functional vision in only one eye and GA in the contralateral eye are often highly motivated to initiate and comply with treatment. These patients understand the experience of lost vision and are eager to preserve whatever vision remains.
Patients who are likely to progress quickly based on imaging results—such as patients with multifocal lesions or fundus autofluorescenc patterns that forecast rapid growth—are great candidates for treatment. However, patients with extrafoveal disease who have not yet experienced significant disruption may be less interested in undergoing therapy than we would like them to be. This is where patient education comes in: it’s on us to educate these patients about their disease and its likely consequences so that they can make a maximally informed treatment decision.
Saradha Chexal, MD: I find personal experience to be highly motivating for many GA patients. Even if they have not yet experienced vision loss due to GA, they often understand the stakes of disease progression if a family member, neighbor, or friend has struggled with vision loss. We still must educate these patients on the value of regular visits, but in these patients, some of the education regarding quality-of-life concerns is already done.
Dr. Kitchens: Convincing a motivated patient to come to the clinic for GA treatments is easy. But how do we motivate patients who fail to grasp the urgency of their disease?
Dr. Chexal: GA is a silent disease until it’s not, so patients who aren’t experiencing vision loss may be less interested in regular visits—and many only become interested after it’s too late to effectively intervene.
In these patients, I find that longitudinal imaging results serve as an effective educational tool. If patients with extrafoveal disease can see how quickly their lesions have grown over a given period, they may be more likely to understand how treatment could benefit them.
Want to hear more from the discussion Dr. Kitchens moderated with Drs. Chexal and Lalwani? Visit the link to listen to their conversation on New Retina Radio.
Dr. Kitchens: What about patients who are just starting to experience symptoms? Is there any hope for them, or is it too late?
Dr. Lalwani: There is hope of buying them time. Patients sometimes best understand this concept via figurative language. I tell my patients to imagine that their two eyes are falling from the sky toward earth, and that using a complement inhibitor is akin to attaching a parachute to their eyes—and the higher up in the sky we deploy that parachute, the more time they will have until landing. Will it stop their eyes from landing on the ground? No. But will it slow the rate at which they fall through the atmosphere? Probably.
Incidentally, I find that this metaphor saves me chair time. Patients quickly understand the concept and are often interested in deploying a parachute after hearing their disease framed this way.
