Interdisciplinary Approach
Collaborative Care
Given the recent expansion of treatment and rehabilitation options for geographic atrophy (GA), collaborative multidisciplinary care is becoming increasingly more important for comprehensive patient support. For routine eye care, the 11-expert panel recommends that patients be seen every 12 months by their primary eye care providers (ECP; optometrist or comprehensive ophthalmologist). The primary ECP can also offer basic dietary and lifestyle counseling (eg, suggest smoking cessation or the use of Age-Related Eye Disease Study 2 supplements, as necessary). In case of disease progression, the primary ECP should refer the patient to a retina specialist as described in the previous subsection.
In the American Academy of Ophthalmology (AAO) three-level model of vision rehabilitation, level 2 services are provided by experienced ECPs who can assess the level of vision loss, recommend interventions, and refer patients to other services as needed. This level of vision…
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Collaborative Care
Given the recent expansion of treatment and rehabilitation options for geographic atrophy (GA), collaborative multidisciplinary care is becoming increasingly more important for comprehensive patient support. For routine eye care, the 11-expert panel recommends that patients be seen every 12 months by their primary eye care providers (ECP; optometrist or comprehensive ophthalmologist). The primary ECP can also offer basic dietary and lifestyle counseling (eg, suggest smoking cessation or the use of Age-Related Eye Disease Study 2 supplements, as necessary). In case of disease progression, the primary ECP should refer the patient to a retina specialist as described in the previous subsection.
In the American Academy of Ophthalmology (AAO) three-level model of vision rehabilitation, level 2 services are provided by experienced ECPs who can assess the level of vision loss, recommend interventions, and refer patients to other services as needed. This level of vision rehabilitation is appropriate for patients whose vision loss limits one or a limited number of activities or tasks, but does not affect their overall function.
Level 3 services require a multidisciplinary team typically composed of a clinician (ophthalmologist or optometrist), rehabilitation professionals (eg, occupational therapists or vision rehabilitation therapists), psychosocial support professionals (eg, social workers or psychotherapists) and other specialists (eg, orientation and mobility trainers).
Patient Challenges and Mental Health
Rehabilitation professionals evaluate the patient’s overall function and provide training on low vision assistive devices and other coping strategies. This work is essential given that people with vision impairment face numerous challenges in their daily life, from basic activities like shopping or cooking, to reduced mobility and independence (eg, due to inability to drive), social exclusion, loss of hobbies and loss of employment opportunities. As a result of these challenges, people with vision loss also have worse mental health than the general population. Clinically significant depression affects 10% to 45% of people with moderate to severe vision loss, while 7% to 16% experience clinically significant anxiety. A 2022 Cochrane review found that various psychological therapies have a small positive effect on vision-related quality of life (low-certainty evidence) and a large and significant effect on depression (very low-certainty evidence). Based on these findings, the AAO recommends psychological therapies (including group therapies) for patients with vision loss.
Trial Recruitment
Finally, beyond the level of individual care, ECPs should maintain communication with clinical researchers and academic centers to foster more effective clinical trial enrollment for eligible patients. Although randomized clinical trials represent the gold standard in evidence-based medicine, many do not meet recruitment targets. In the context of GA, one of the key challenges is that entry criteria typically mandate fundus autofluorescence (FAF) imaging, and FAF is relatively rare in clinical practice compared to optical coherence tomography. Patient recruitment is usually done through electronic health records, but these may have inaccuracies and inconsistencies, reducing the overall efficiency of the process. Although recent advances in AI-based optimization methods may improve trial recruitment efficiency, ECPs can help by being aware of ongoing trials and identifying patients who may meet trial eligibility criteria.
References
- Abdelsalam A, Del Priore L, Zarbin MA. Drusen in age-related macular degeneration: pathogenesis, natural course, and laser photocoagulation-induced regression. Surv Ophthalmol. 1999;44(1):1-29.
- Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA. 2013;309(19):2005-2015.
