Geographic Atrophy Management in Clinical Practice

Eleonora M. Lad, MD, PhD: We’ve talked a lot about the challenges associated with geographic atrophy, and the trouble is there are no FDA-approved treatments for this disease. Given that there are no treatments, Jay, how are you managing patients with geographic atrophy in your clinical practice?

Jayanth Sridhar, MD: There are always 2 components to management. One is counseling and treatment recommendations, and the second is follow-up and what we do with that. I’ll hit on the first, which is risk-factor modification and doing whatever we can to lower risk factors: UV light protection, smoking cessation, exercise, diet. AREDS [Age-Related Eye Disease Study] and vitamins for geography atrophy aren’t clear cut. I’m curious what the rest of the panel does. I usually tell the patient it’s not going to hurt anything and that if it was me, I’d take them. It’s controversial. The data aren’t there if they’re bilateral of geographic atrophy, but I’d probably take them.

The final thing is when do you see these patients? Historically, we haven’t seen these patients as often, compared with our patients with wet macular degeneration, because there isn’t any rapid progression or intervention we’re offering. I see these patients every 4 to 6 months depending on what else is going on in their lives. In recent times—we’ll talk about some of the emerging treatment options—I’ve shortened that interval to get patients used to the idea that we may be seeing each other more often if treatment becomes available. But I’m curious what the rest of you do, especially regarding AREDS.

Nancy M. Holekamp, MD, FASRS: I’ll go back to the AREDS trial, which did a post hoc analysis on geography atrophy. It showed no benefit on geographic atrophy lesion size or growth rate. If we’re going to recommend it, there may be some immediate in eye if the eyes are asymmetrical or if it was shown to decrease the rate toward CNV [copy number variations]. But AREDS vitamin hasn’t been shown to affect the growth rate of geographic atrophy. David, do you agree with that?

David R. Lally, MD: Yeah, I agree 100%. I think about that same study when I have a patient with bilateral GA. I typically ask patients about their diet. I say that if you eat the all-American diet of hot dogs and ice cream each day, you may not be getting the nutrients that your retinal cells need. It’s OK to take the AREDS vitamins because you may be getting nutrients that could have some benefit. On the other hand, if you eat a very well-balanced diet, like a Mediterranean diet, and you’re careful about getting nutritious food, you’re probably getting enough of the nutrition based on that subgroup analysis from the AREDS study.

Eleonora M. Lad, MD, PhD: AREDS vitamins aren’t FDA approved for treatment in these patients, but the use of these vitamins is in a post hoc analysis. Some of our patients have trouble with large pills. Fortunately, there’s a chewable option. I thought I’d mention it because it’s a practicality that’s important.

Jayanth Sridhar, MD: The other practicality is cost. Insurance doesn’t approve this. For some of our patients, it’s not a problem. They’re willing to spend any dollar they have. But that’s also something we assess when we meet them the first time. Besides their lifestyle, what are their resources? Is it going to be a significant cost burden? As you said, Nancy, we don’t have data to support it. That’s when I’ll say that maybe we should lean toward the dietary modification things. It may be better to put your dollar there instead of toward the vitamin.

Transcript edited for clarity