Managing Geographic Atrophy in a 90-Year-Old Patient with Coexisting Neovascular AMD and Recurrent CNV Activation

In this segment, the expert faculty examine a complex case involving a 90-year-old man with decreased vision, underlying geographic atrophy (GA), and a history of choroidal neovascularization (CNV). Multimodal imaging revealed atrophy in both eyes, with the left eye additionally displaying subretinal fibrosis from prior neovascular disease. They discussed the challenge of distinguishing GA from atrophy secondary to neovascular AMD—an important consideration because clinical trials of complement inhibitors did not include patients with preexisting CNV. After shared decision-making, the patient elected bilateral treatment, beginning with the worse eye. The care team used pegcetacoplan for GA and added aflibercept when new intraretinal fluid indicated CNV reactivation. Faculty explored varied real-world strategies, including whether to pause complement therapy, split visits, or treat both conditions concurrently. They emphasized individualized management, careful imaging review, intraocular pressure control, and clear counseling about treatment expectations and adherence in this dual-disease population.