Symptoms and Manifestations of Geographic Atrophy

Veeral Sheth, MD, MBA: When we talk about geographic atrophy, one of the interesting things is, for the longest time, we really didn't talk much about geographic atrophy in our clinics, especially not with our patients. Because it's this nebulous type of dry macular degeneration, we didn't have treatments, so it wasn't really worth a lot of conversation because it didn't go anywhere with patients. And so, we're talking a lot more about it now, obviously, because we have a couple of new therapeutics that were introduced in 2023.

We're a lot more excited about talking about it, we're talking to patients about it because there's a potential of offering them a therapeutic. And so when we do talk to patients, how do I describe geographic atrophy, atrophy for that patient? I say, look, it's a form of dry macular degeneration because I think patients are still pretty familiar with the fact that there is a wet type and a dry type. And I tell them it's an advanced form of dry macular degeneration, for which, for the longest time, we had no therapies. For us, as clinicians, what we've noticed is that, or at least what we've thought, historically is that this is a pretty slow-moving disease.

And I think part of that is because when you don't have treatments for these types of things, you don't pay as much attention to it, or you don't see these patients maybe as often. And not just that, when we measure patients' vision, for example, we could have patients that have geographic atrophy, that's progressing pretty significantly, that are still 20/20 or 20/30. And so when we're quickly going through patients in our clinic, and we're just looking at vision, and we're making sure that there's no fluid on the OCT, we're not often kind of appreciating the fact that this disease actually may move a little more quickly than we thought. And if you look back at the data now, it does look like it moves in many patients pretty quickly.

That's something that I think we need to recognize as clinicians and then, when we talk to patients about it patients will come in 20/20 and they'll complain about having more trouble driving, more trouble reading. Someone was walking across the crosswalk, and I didn't see him right away. So things like that, that actually affect their daily life, but that we don't necessarily see in the measurements that we do in clinic, but we're starting to recognize the fact your to your question, which is, how does it affect patients?

Before they lose central vision, they're still becoming symptomatic and then sometimes that means just as the quality of vision is degrading so there again, like I said, having more difficulty doing daily life activities, reading and driving being two of the more common ones, things like being able to see the ticker on the television or see someone's face from across the room. Things like that are the things that you'll hear pretty routinely in the clinic, from the patients that are suffering from this disease.