BLOG: Cross my heart and hope to die, or stick a needle in my eye?
In the cover story of this issue of Ocular Surgery News, we explore emerging treatments for the subset of patients with dry age-related macular degeneration who have geographic atrophy.
While this condition affects far more patients than wet AMD — and this number is likely to grow — there are at least three factors that make the treatment of geographic atrophy (GA) different from that of the wet form of this disease.
1. Patients with GA are harder to find. With wet AMD, most patients are already under the care of a retina specialist and receiving injection therapy. It’s easy to avail this population of emerging treatments because they are already being seen at least four times a year. By contrast, many patients with GA don’t see an eye doctor at all, or if they do, their general ophthalmologist or optometrist might hesitate to refer them to a retina specialist.
2. Patients with GA are less motivated. The untreated pace of visual loss among patients with wet AMD is brisk and impossible to ignore. Patients are extremely motivated to avoid progression. Injection therapy, while unpleasant, is accepted, even at a monthly frequency for almost 1 million Americans. By comparison, the visual loss with GA is much more insidious, dropping vision by perhaps one line per year. And the benefit of injection drugs, according to current studies, can take 6 months or more. Sadly, among these older patients with GA, many will “cross their hearts and hope to die,” rather than allow a doctor to “stick a needle” in their eye.
3. Our best hope is to catch GA earlier. If we can better identify patients whose earliest signs of AMD are precursors to GA, these new treatments may be life changing. Preventing progression at 20/30 is far more exciting than doing so at 20/100. Genetics and other efforts at risk stratification may soon help us identify patients at an earlier age, perhaps around the time of cataract surgery, where one can imagine it could one day become standard of care to do risk analysis for future development of GA.
The availability of breakthrough treatments for GA should bring much enthusiasm from our specialty. Although reality may limit their rapid growth, we owe it to patients to find the best candidates and prevent life-altering loss of vision as early as we can.