Current and Emerging Treatments for Geographic Atrophy and When to Initiate Therapy

The discussion centered on 2 complex patient cases involving macular degeneration and geographic atrophy, emphasizing individualized treatment decisions. One case involved an active elderly patient with differing vision levels between the eyes. Imaging with autofluorescence and optical coherence tomography demonstrated areas of complete outer retinal atrophy, as well as regions of hyperautofluorescence at the borders. The variability in visual acuity among patients highlighted the importance of considering the full clinical picture when deciding on treatment. Decisions were influenced not only by clinical findings but also by age, lifestyle, activity level, and patient goals. This approach reinforces that treatment should be tailored to each patient rather than relying solely on standard metrics.

Monitoring strategies were discussed for patients who may not initially receive treatment. Recommended intervals ranged from 3 to 6 months, depending on the risk of conversion to wet macular degeneration and the type of imaging available. Consideration of comorbidities and other ocular risk factors, such as glaucoma history, also informed the discussion. In one case, the patient elected to begin monthly therapy to maximize potential benefit, and later, when the patient developed wet macular degeneration, both eyes were treated on the same day to minimize visits. This decision underscored the importance of partnering with patients to develop a plan that aligns with their preferences and lifestyle.

The second case involved a patient with neovascular age-related macular degeneration and atrophy, highlighting treatment complexity and differing practice patterns. Imaging over 10 years demonstrated significant progression in one eye while the other maintained good vision. Treatment decisions were guided by patient priorities, including travel plans, and the goal of maintaining vision while minimizing treatment burden. Across both cases, the overarching lesson was the importance of communication, education, and patient empowerment. Patients who are actively engaged in treatment decisions are more likely to adhere to therapy, resulting in better outcomes. Personalized care, supported by data and patient collaboration, is essential in managing complex retinal conditions.