Points of View: Geographic Atrophy

Sheppard, MD: Primary eye care providers can follow patients annually and then more frequently if pathology becomes apparent. Retina specialists can educate providers regarding appropriate screening techniques and referral triggers.

Adyanthaya, MD: This is one of the areas where integrated eye care can work well to preserve vision. As we know, patients usually present to either optometrists or general ophthalmologist for primary eye care. In the past, there was no treatment for geographic atrophy. Due to this, unless there was conversion to wet macular degeneration, patients were usually not referred to a retina specialist. Due to the recent approval of treatments, patients who have signs of geographic atrophy should be referred to a retina specialist to determine if they are suitable candidates for treatment. If the patient has a large patch of geographic atrophy involving the fovea with long-standing poor vision (20/200 or worse) or if the patient is not able to keep up with bimonthly treatment appointments, then I would consider these patients to be poor candidates, and they need not be referred.

Rachon, OD, FAAO: As primary eye care providers, optometrists need to identify these patients, and we need to get them the proper care that they need. As far as geographic atrophy goes, optometrists are often having a discussion with the patient first because we are identifying it. We need to be aware of all the medical treatments available, and we need to be comfortable discussing them with patients. General ophthalmology is the same and might catch a lot of these cases early with comprehensive eye exams. General ophthalmology can help in a unique way because if patients need surgery, for example, if they have dense cataracts and the retina specialist needs to have a better view in the back of the eye, or our OCT machine is not getting good quality scans, our general ophthalmology colleagues are going to be important in removing those cataracts or treating other concomitant diseases such as glaucoma that might need surgery. Our retina specialists are going to decide with the patient whether geographic atrophy treatment is right for them. At that time, the retina specialist can refer back to either general ophthalmology or to optometry, especially if we have low vision services where we can trial magnifiers and telescopes for patients to help maximize their potential vision.