Imaging Modalities in Geographic Atrophy

Eleonora M. Lad, MD, PhD: What about caregivers? What do you communicate to the caregivers? Do you use imaging as a tool? I’m hopeful that in the future we’ll have AI algorithms that’ll help us predict progression of disease a little better so we can advise the patients and caregivers, but what do you do now to advise the family?

David R. Lally, MD: I think Jay hit on this point earlier, and he hit the nail right on the head, which is I typically use OCT [optical coherence tomography] imaging. I agree with Nancy, you said you use autofluorescence and if I had enough time in my private practice clinic, I would love to get autofluorescence on every macular degeneration patient. But that test sometimes takes time in our clinic, and we don’t have the resources to obtain that image, so often I’m using OCT. One thing I forgot to mention earlier is, I actually like the infrared on the OCT, and I should have mentioned that previously because the infrared shows the geographic atrophy lesion very well. It’s an easy thing on my OCT machine to show the patient and put the 2 images up side-by-side, maybe their baseline image and their present image, or show them each year how those GA [geographic atrophy] lesions have expanded. To Jay’s point, if the patient is dilated, it’s hard for them to see. A caregiver has a good understanding of what’s going on because these patients may be coming in and they’re still hitting the same visual acuity and they’re complaining, and the caregiver is thinking, “Well, the vision looks OK, they said the vision was all right, is my mom or dad, or loved one really having a worsening problem?” The infrared will show them, yes, this is a serious issue. This is a progressive disease. And every time you’re coming in, we’re seeing progression. It’s not something that’s slow. We see signs of progression each time you’re here.

Jayanth Sridhar, MD: I agree with you, Dave. I love the infrared on OCT imaging. You can show progression of atrophy over time. This ties into Nancy’s point, when you were talking about preparation in terms of how the caregiver and the patient, what does true blindness mean with this condition? It’s important for the caregiver to understand, what is this person going to be able to do if they reach “the floor” of this disease? Well, they’ll still be able to do a lot of their activities of daily living, and I think that’s important for planning purposes, that they still can ambulate to a restroom, they often can take care of and groom themselves. The things that are going to be struggles are going to be reading, facial recognition, and watching television, if that’s something important to them. These entertainment things that are important to people’s lives. Those are the things that are drastic, and of course, driving is something that all patients and caregivers are thinking about. It’s a constant argument between caregivers and the patients, whether or not they can drive, and we end up being the arbiter, and that’s sometimes a tough conversation to navigate.

Transcript edited for clarity