Challenges Reported by Young Physicians in Managing Geographic Atrophy and How these Shape Patient Care

The discussion focused on the current treatment landscape for geographic atrophy, highlighting 2 approved medications and ongoing investigational therapies. Key clinical trial data, including rates of growth reduction and visual benefit, were reviewed. These findings demonstrated that both medications show increasing efficacy over time, supporting the importance of early initiation of therapy. Considerations such as when to start treatment, when to withhold it, and how patients who develop wet macular degeneration should be managed were also emphasized. Even if treatment is paused, atrophy may continue to progress, so clinicians must counsel patients carefully about long-term expectations.

Patient presentation plays a critical role in treatment decisions. Symptomatic patients with documented progression are often easier to engage in therapy, while others may require more education to recognize the worsening of their condition. Imaging modalities, including near-infrared color photography, fundus autofluorescence, and optical coherence tomography, help demonstrate disease progression. Discussing these findings with patients requires a balance of clarity and depth depending on the patient’s background. Some patients prefer detailed explanations with supporting data, while others benefit from simpler explanations emphasizing that treatment slows retinal degeneration rather than reversing it.

The discussion also covered adverse events and treatment risks, such as inflammation, retinal vasculitis, and ischemic optic neuropathy. By providing thorough pretreatment counseling, patients are better prepared for potential complications. Timing and dosing frequency were examined, including surprising findings that every-other-month dosing may sometimes provide slightly better outcomes than monthly dosing. Overall, the key takeaway is that personalized treatment planning, informed by trial data and patient characteristics, can maximize visual preservation while considering treatment burden. Early initiation of therapy offers the greatest potential benefit, highlighting the importance of ongoing patient education and engagement.