Emerging treatments for geographic atrophy and the impact on clinical management of age-related macular degeneration

Age-related macular degeneration (AMD) is a leading cause of vision impairment in people over 50 years of age and has a great impact on quality of life as it affects central vision. Although there have been treatments available for the neovascular form of late AMD for decades, until now there have not been treatments available for the atrophic form of late AMD - geographic atrophy (GA). Recently, treatments acting on the complement pathway have been approved by the United States Food and Drug Administration, with other jurisdictions such as Australia considering their approval. Furthermore, there are many more potential treatments for GA currently in clinical trials. However, unlike the treatments for neovascular AMD, where clinicians have treated virtually all patients presenting with exudation, the decision to treat those with GA will be more nuanced and individualised. Longitudinal retinal imaging will be one important asset that will help tremendously when counselling patients, as through these images, the growth pattern of the atrophy can be determined. Even without individual prior imaging history, there are other imaging clues to help predict growth rates and threats to the fovea, and hence imminent vision loss. Optometrists have a critical role in this new era where GA treatments will be available, as they are often the first to have contact with GA patients. Insightful, well-informed counselling and appropriate referral for those seeking more information on potential treatment to confirm the diagnosis and perform baseline imaging at a location likely to undertake any future treatment will ensure that appropriate patients have had the best workup to be individually managed once these treatments arrive in Australia.