While every practice has its own unique method of navigating and supporting patients through significant diagnoses, our mission as providers should be to support our patients, granting them the knowledge and autonomy to have as much control as possible. In the context of geographic atrophy (GA), that means supplying patients with the appropriate information and relevant supplementary data to make decisions about treatment.
My conversations about GA are tailored to every patient’s individual circumstance, and as such, this does take more time than with other retinal diseases. GA is a complex disease. However, providers should not feel overwhelmed by the extra chair time needed to properly educate patients about their options.
Easing Patients’ Minds
Patients often have many questions upon hearing about a diagnosis of age-related macular degeneration (AMD) or GA. We should be cognizant of the fact that a new diagnosis can be scary, and we should work to assuage those fears. For instance, I am often asked, “Will I go blind?” Thankfully, I can reassure patients that their peripheral vision will remain intact whereas they may lose central vision. Another common question I am asked is, “Are the injections working?” This involves a more complex answer. In patients with wet AMD, I can show evidence of the fluid reduction on OCT following treatment. To answer this question for patients with GA, however, I must rely on clinical trial data. The pivotal studies for the two available complement inhibitors involved thousands of patients followed over multiple years, and as practitioners, we trust the scientific data that these approved treatments have measurable, real benefits in reducing the growth of GA lesions over time.
Educating Patients
When educating about GA, I intentionally break up the discussion over a few visits. Not only are patients trying to comprehend the clinical information presented to them, but they are also emotionally processing a life-altering diagnosis. I provide patients with brochures for avacincaptad pegol intravitreal solution, (Izervay, Astellas) and/or pegcetacoplan, (Syfovre, Apellis), depending on which drug I would recommend to the patient. Furthermore, I rely on imaging to show patients their actual GA lesions. This makes their disease more real, especially in cases where patients are minimally symptomatic because their GA was detected early. It’s powerful when patients observe the imaging for themselves, and usually the picture says it all for them. Additionally, I aim to perform fundus autofluorescence imaging around every 6 months, so I can visually follow the patient’s disease progression.
Navigating a Patient’s Journey Through Clinic
Initially, the logistics of scheduling GA patients in clinic were challenging as we were scheduling injections into an already busy clinic schedule or navigating the schedules of patients already coming in for their wet AMD injections. However, the process has become more streamlined, especially for existing patients receiving anti-VEGF treatment, as they are more familiar with injection protocols. One way we cut down on the treatment burden among patients being treated for both wet AMD and GA is to use newer generation anti-VEGF agents, such as Vabysmo (Faricimab, Genentech) or Eylea HD (aflibercept 8 mg, Regeneron), which offer extended treatment intervals.
Remaining Hopeful Yet Honest
It’s no secret that GA is a potentially blinding condition and is often a very discouraging diagnosis. As retina specialists, I believe we must reiterate to our patients that a diagnosis of GA is a balance of hope and honesty. The currently available drugs provide some amount of hope, which is by far the most important thing. I am grateful I can offer treatments to patients that have proven to be efficacious with a decent safety profile.
It is also important to remain honest with patients and relay that, despite treatments, their GA will progress. This approach allows patients to anticipate a potential loss of vision, while not providing them with false expectations about their disease progression.
Although the currently available therapies for GA are not curative, they may provide a few additional years of increased quality of life with manageable side effects. This means perhaps experiencing a few more years of driving or seeing loved ones faces. And, at the very least, starting patients on complement inhibitor therapy now may serve as a bridge to even better future treatments, as GA is a very active area of research in the retina space.
