The approach to managing geographic atrophy (GA) patients has evolved significantly in recent years. Historically, these patients were often referred at advanced stages when vision loss was severe, and treatment options were virtually nonexistent. These encounters were particularly challenging because there was little we could offer beyond monitoring the inevitable progression of the disease.

Today, the timeline for assessing GA patients has shifted. I now prioritize seeing patients at the earliest signs of GA. This proactive approach lets me monitor the speed of progression closely and initiate treatment as soon as patients become eligible. Imaging modalities, such as fundus autofluorescence and optical coherence tomography, are invaluable tools for detecting and tracking GA. These technologies provide detailed insights into disease extent and progression, enabling us to make timely and informed treatment decisions. Early intervention is crucial in slowing the progression and preserving as much vision as possible.

Since 2023, we have had two FDA-approved medications for GA, and many of my patients are thriving on these newly available therapies. Safety considerations play a significant role in treatment planning and my discussions with patients regarding initiating GA therapy. The main risks I discuss include retinal vasculitis, inflammation, choroidal neovascularization, and endophthalmitis. While endophthalmitis risks are comparable to those associated with other intravitreal injections, retinal vasculitis and inflammation have been reported with some commercially available GA therapies. To mitigate these risks, I never initiate bilateral injections simultaneously. Instead, I start with the worse-seeing eye and wait 6 weeks before proceeding with the fellow eye, provided there are no signs of inflammation from the initial injection. For monocular patients or those with a history of inflammation, I am more likely to select avacincaptad pegol (Izervay, Astellas) given its reduced association with retinal vasculitis.

Patient communication is another critical component of managing GA. Setting clear expectations is essential. Current first-line therapies do not stop or reverse the disease; they only slow its progression. For all my GA patients, I review their imaging with them at every visit to help them understand the anatomy, disease findings, and progression over time that dictates our rationale for ongoing treatment. 

By addressing these aspects—early diagnosis, advanced imaging, tailored safety measures, and transparent communication—our office dynamics have transformed into a proactive and patient-centered approach to managing GA that ensures patients feel supported and empowered as we navigate their care together.

Mona Camacci, MD, MS is a Board-Certified ophthalmologist at Retina Consultants of South Carolina.