This column is the fourth in a series on the comanagement relationship between optometrists and ophthalmologists when diagnosing and treating patients with geographic atrophy.

Once a patient with geographic atrophy (GA) begins treatment with a retina specialist, regular injections, imaging, and monitoring can quickly become the primary focus of the patient’s eye care.

That does not mean the role of the primary eyecare provider has ended. Geographic atrophy care works best when referral represents a transition to collaborative care rather than a transfer of care. The retina specialist assumes responsibility for GA treatment and monitoring, while the optometrist or comprehensive ophthalmologist continues to manage the patient’s broader visual and ocular need. 

Different Roles, Shared Goals

The roles of each doctor can be relatively straightforward. The retina specialist determines treatment candidacy, administers complement inhibitor therapy, monitors GA progression, and evaluates for conversion to exudative age-related macular degeneration (AMD).

Patients with GA often have refractive needs, ocular surface disease, glaucoma, cataract or posterior capsular opacification that also affect visual function. Not every change in vision should automatically be attributed to GA. Comprehensive eye care can identify and treat these potentially modifiable contributors. For patients with more advanced disease, low vision services and strategies to optimize remaining vision may become increasingly important.

The goal is not for both doctors to perform the same functions. It is for each to remain engaged where they can provide the greatest value. 

Keeping Patients Connected

Maintaining that relationship starts before the referral. I tell patients that seeing a retina specialist does not mean they are leaving our optometric service. We typically schedule them back approximately 6 months after referral rather than leaving follow-up open-ended.

At that visit, we confirm that the retina consultation occurred and whether treatment was initiated. We review the retina specialist’s findings with the patient and reinforce the treatment plan. For patients receiving complement inhibitor therapy, we assess how they are tolerating injections, reinforce the goals and expectations of treatment, and answer questions that may have surfaced after several months of therapy. We also obtain updated imaging to assess disease progression while addressing broader ocular needs, including ocular surface disease, intraocular pressure, refractive status, and other conditions affecting visual function.

The retina specialist can reinforce that frequent injection visits do not replace routine comprehensive eye care. Communication between practices does not need to be complicated. The primary eyecare provider should know whether treatment was initiated and whether meaningful progression or conversion has occurred. Likewise, changes identified between retina visits, including new distortion, scotoma, or unexpected visual decline, may warrant communication with the retina specialist.

Consistent messaging remains important throughout treatment. When patients hear similar explanations from 2 doctors they trust, they can feel more confident in the treatment plan and better prepared for the long-term commitment therapy requires.

Conclusion

Collaborative GA care does not require both doctors to do the same thing. It requires clear roles, useful communication, and recognition that the patient has visual needs beyond the disease being treated.

Damon Dierker, OD, FAAO, is the director of optometric services at Eye Surgeons of Indiana in Indianapolis. Dr. Dierker is a consultant for Biogen and Astellas.

Ankur M. Shah, MD, FASRS, is a fellowship-trained ophthalmologist and retina specialist at Retina Partners Midwest, PC at Midwest Eye Institute in Carmel, Indiana. Dr. Shah is a consultant for Biogen and Astellas.

This editorially independent content
is supported by Biogen.