In a period of just six months last year, the FDA approved two medications proven to slow the progression of geographic atrophy (GA), ushering in a new era of hope for patients, as well as a sense of urgency for eyecare providers. If left untreated, GA lesions can start encroaching on the fovea in only 2.5 years,¹ causing irreversible vision loss. Timely referrals and efficient co-management have never been more important. Here, Mile Brujic, OD, and retina specialist Arshad M. Khanani, MD, MA, FASRS, share best practices for optimizing the co-management relationship. 

Referral Essentials 

As primary eyecare providers, optometrists play a vital role for patients with GA. 

“It’s critical for us to identify early signs of disease and get these patients into the hands of retina specialists without delay,” Dr. Brujic says. “A prompt referral helps establish the patient’s relationship with the retina specialist, who will determine whether or not treatment is warranted.” 

Dr. Khanani notes that many patients in the early stages of GA do not have symptoms. “Any sign of geographic atrophy on examination, OCT, or color fundus photo-graphy should prompt a referral, even if a patient has 20/20 visual acuity,” he says. “This enables us to begin a conversation about what treatment involves, its risks and benefits, and, importantly, what outcomes can be expected. The sooner we treat, the sooner we slow disease progression and the longer the patient has before central vision is threatened.” 

“The great news is we don’t need advanced diagnostics to identify geographic atrophy,” Dr. Brujic says. “A comprehensive assessment of the macula should give us the information we need to detect the disease. That said, advanced retinal imaging systems do a remarkable job of helping us track and monitor GA over time.” 

Dr. Khanani concurs. “The referring physician’s examination notes, including the patient’s history and the duration of the disease, are essential in a referral,” he says. “Fundus autofluorescence, color photo-graphs, or OCT images showing disease progression, if available, can facilitate my discussions with patients about treatment.” 

Clarify Co-Management for Patients 

“Co-management is a two-way street, and it’s important for us to explain this process to patients,” Dr. Brujic says. “They need to understand that while the retina specialist is focusing on their geographic atrophy, we as their primary eyecare providers will continue to manage any other ocular conditions that they may have. To that end, we must be sure to establish regular follow-up with patients after they’ve seen the retina specialist. The referral pattern has to be crystal clear, so patients know who is caring for what aspect of their vision.” 

Dr. Khanani adds, “Patients need to understand that their optometrist is not transferring care, but rather is sending them to a specialist who can intervene specifically in their retinal disease. I remind patients that they must return to their optometrist for routine eye care, and I explain that their optometrist and I share our findings with one another regularly.” 

Engage and Motivate 

“We worry about dropout in terms of compliance because the current treatments do not improve vision,” Dr. Khanani says. “It will continue to worsen—but without treatment, it will worsen even faster. 

“Optometrists have established relationships with their patients, and they’ve gained their patients’ trust,” Dr. Khanani continues. “We look to them, first, to motivate patients to come and see us, and then to continue motivating them to persist with therapy, showing confidence in the provider they’re referring to.” 

In closing, Dr. Brujic notes, “It’s incumbent upon optometrists to be critical when examining patients for geographic atrophy. The sooner we can identify changes in the tissue, the sooner these patients can start treatment to lengthen periods of sustained good visual acuity.” 

Mile Brujic, OD, FAAO is a partner at Premier Vision Group, an optometric practice with four locations in Northwest Ohio. He is a consultant for Astellas.

Arshad M. Khanani, MD, MA, FASRS is director of clinical research at Sierra Eye Associates in Reno, Nev., and a clinical professor at the University of Nevada, Reno School of Medicine. He is a consultant for, and receives research support from, Astellas and Apellis Pharmaceuticals.

REFERENCE: 

1. Lindblad AS, Lloyd PC, Clemons TE, et al. Change in area of geographic atrophy in the Age-Related Eye Disease Study: AREDS report number 26. Arch Ophthalmol. 2009;127(9):1168-1174.

THIS EDITORIALLY INDEPENDENT CONTENT IS SPONSORED BY ASTELLAS