Tackling early detection of geographic atrophy with the power of referrals

With anticipated treatments emerging for geographic atrophy (GA), the landscape of managing and diagnosing the disease has already seen significant shifts. Studies^1,2 have shown that early identification is vital to stopping the progression of GA, which can be aided by effective comanagement between retina specialists, optometrists, and ophthalmologists. Priya S. Vakharia, MD; and Deepak Sambhara, MD, FASRS, have identified the importance of successful referrals and gave their tips to ensure the early detection of GA for optometrists to take back to their practices.

"There still seems to be a disconnect, personally speaking, with the types of referrals that come in from an optometrist for geographic atrophy to an ophthalmologist," said Sambhara. "I think the risk factors that predispose patients to quicker progression is something that we should really highlight. So what do those risk factors look like? We know that non-subfoveal lesions grow quicker than subfoveal lesions, so that's something to pay attention to.

"The other thing is, multifocality is another predictor of progression. We know that multifocal lesions grow quicker than unifocal lesions. There are certain multimodal imaging characteristics like perilesional hyper autofluorescence. So if an optometry clinic happens to have autofluorescence imaging, I do think it's a great tool. But to me, characterizing the actual lesion, because not all GA is created the same, and so to know who's more likely to progress than others, it gives me a better way to start that conversation with the patient who might be sent over."

"I think the thing that we are increasingly realizing is treating GA earlier, before it becomes visually significant, is actually way better," said Vakharia. "We know that the rates of progression for extrafoveal disease is higher than for foveal involvement, and to try to catch those patients earlier is helpful. So I think the biggest thing I would wish is that even if there's a patient with extrafoveal disease who may not be symptomatic, to get them in just to see us so we can talk about treatment options."

References:

1. Regillo C, Nijm LM, Shechtman DL, et al. Considerations for the identification and management of geographic atrophy: Recommendations from an expert panel. Clin Ophthalmol. 2024;18:325–335. doi:10.2147/OPTH.S445755
2. Kaiser PK, Karpecki PM, Regillo CD, et al. Geographic atrophy management consensus (GA-MAC): a Delphi panel study on identification, diagnosis and treatment. BMJ Open Ophthalmol. 2023;8(1):e001395. doi:10.1136/bmjophth-2023-001395