Points of View: Geographic Atrophy

John D. Sheppard, MD, (ophthalmologist): A diagnostic hurdle for geographic atrophy is provider awareness. What’s key is making the diagnosis prior to loss of fixation in the more severely affected eye as well as proactive retinal imaging.

Rohit Adyanthaya, MD (ophthalmologist): The main hurdle is that patients with extrafoveal lesions are usually asymptomatic. Unless the geographic atrophy lesions involve the fovea, most patients will have good vision, especially if they are just told to read the Snellen visual chart. Because they have good vision, a dilated eye exam may not be performed, so extrafoveal geographic atrophy lesions may be missed. The irony is that treating patients at this stage probably provides the most benefit, but unfortunately due to the reasons mentioned above, they are not diagnosed until the lesion invades the fovea and patients lose vision. Hence, a dilated exam and OCT scans of the macula are important for early diagnosis.

Katherine Rachon, OD, FAAO (optometrist): The biggest diagnostic hurdle is the availability of technology in offices. Early geographic atrophy or the pending signs of upcoming geographic atrophy can be missed even with a dilated eye exam. We use OCT to detect geographic atrophy by looking at the atrophy of the retinal pigment epithelium, the photoreceptor layer and the choriocapillaris. The other important clinical tool that we use is fundus autofluorescence. It allows us to see geographic atrophy as a hyporeflective spot or a black spot in the photo. These two tests that we normally use in clinic are also important to look for progression of geographic atrophy. There are some things we look for on the OCT, pseudodrusen and reticular drusen, that can indicate that geographic atrophy is pending or progressing. These two machines that do these tests are important for monitoring geographic atrophy, and not all eye doctor offices have them.