This article was originally published in a sponsored newsletter.
Geographic atrophy (GA) remains a formidable opponent to patients and physicians. The condition can smolder slowly with little change or progress rapidly with little warning. Unfortunately, not all patients will obtain a good outcome, despite current treatment options and good intentions. How do we provide hope for a disease process that can be so unrelenting?
It is important to have ample face time with GA patients to help them understand the condition and goals of treatment in a way that makes anti-complement injections a reasonable option. Unlike anti-VEGF agents, anti-complement injections rarely provide meaningful vision gains. In fact, most patients still lose vision despite our best treatment efforts. I often cite data from the GATHER trials, but that is not the crux of my conversation. I spend most of my chair time with these patients and their families or caregivers discussing the pathology of AMD and GA, reviewing images, and trying to ascertain any specific goals they have regarding their vision or treatment.
If you have temporal autofluorescence images available, showing disease progression can have a profound impact on patients’ willingness to proceed with treatment. These images can be especially helpful in cases of foveal-sparing GA. Imagine how difficult it would be to rationalize eye injections if you had no subjective vision complaints. That said, I rarely treat at the first visit. Instead, I provide reading materials and give patients time to review treatment options and discuss their condition with friends and family.
As for the injection process, I recommend that you utilize techniques with which you are comfortable. Consider lidocaine gel numbing agents for the decreased risk of irritation from cotton pledgets. Remind patients that they may lose vision for a short period after treatment because of the increased volume of medicine injected. Our office provides patients with a printed list of common and uncommon side effects as a reference, which lets them focus more on the pathology and treatment during the visit as opposed to potential complications. The goal is to meet each patient’s needs and make them feel at ease with the entire visit. When you address questions and concerns proactively to make subsequent visits easier for patients, their families, and the medical team, you work toward instilling trust and fostering a relationship to make a potentially difficult condition more palatable.
Geographic atrophy is a difficult pathology, but we can now provide patients with the hope of potential stability. Most patients are highly motivated to maintain their livelihood and remain active, so take time to address their concerns, answer their questions honestly, and involve loved ones in management discussions. If necessary, provide recommendations for outside vision resources, including low vision services. I am constantly asked the question, “If this were your parent, what would you recommend?” Happily, I can say I fully believe in our current treatments and try to instill the same confidence in our patient population.
