On this episode of Ready, Set, Retina, Daniel Epshtein, OD, FAAO, sits down with Murtaza Adam, MD, to review a case of geographic atrophy (GA) and discuss optimal patient selection for complement inhibition treatments.
Dr. Adam is a vitreoretinal specialist and the Chair of Clinical Research at Colorado Retina in Denver, Colorado.
Geographic atrophy case report
A 70-year-old female patient was referred to the clinic by her primary eyecare provider for GA OS. The patient’s best-corrected visual acuity (BCVA) was 20/30 OD and 20/25 OS, and she denied any vision changes. The patient was phakic OU, with no pertinent ocular history, and was otherwise healthy and active.
Figure 1: Baseline color fundus photography (CFP) and optical coherence tomography (OCT) imaging OD; on fundus photography, there is a significant amount of central soft drusen and peripheral calcific drusen as well as a contracted Weiss ring associated with a posterior vitreous detachment (PVD). The OCT shows a mild epiretinal membrane (ERM) and a high volume of soft and shallow drusen consistent with intermediate AMD.
Figure 1: Courtesy of Murtaza Adam, MD.
Figure 2: Baseline CFP and OCT imaging OS; on fundus photography, there is a significant amount of central soft drusen and peripheral calcific drusen as well as a deep red choroidal flush underneath the nasal macula, suggesting the presence of atrophy. The OCT shows a similar volume of drusen as the left eye and a choroidal hypertransmission defect.
Figure 2: Courtesy of Murtaza Adam, MD.
Figure 3: Baseline CFP OD with corresponding fundus autofluorescence (FAF); FAF shows a stippled mix of hyper- and hypoautofluorescence consistent with drusen, but no signs of GA.
Figure 3: Courtesy of Murtaza Adam, MD.
Figure 4: Baseline CFP OS with corresponding FAF; FAF demonstrates a relatively large area of multifocal GA that is 2 to 2.5 disc diameters in size, and there is hyperautofluorescence at the edges of the lesion, which is a risk factor for progression.1
Figure 4: Courtesy of Murtaza Adam, MD.
To learn more about spotting biomarkers of GA progression on imaging, check out How to Identify Geographic Atrophy Early with Multimodal Imaging!
GA management
Ultimately, Dr. Adam diagnosed the patient with intermediate AMD OD and GA OS, and recommended that they pursue treatment with intravitreal complement inhibitor therapy every 6 to 8 weeks.
In 2023, the US Food and Drug Administration (FDA) approved two intravitreal complement inhibitors for the treatment of GA secondary to AMD:2
- SYFOVRE (pegcetacoplan, Apellis Pharmaceuticals)
- Approved February 2023
- Complement factor 3 (C3) inhibitor
- IZERVAY (avacincaptad pegol, Iveric Bio, an Astellas company)
- Approved August 2023
- Complement factor 5 (C5) inhibitor
To learn more about optimal patient selection for complement inhibition therapies, watch the full episode!
Conclusion
GA presents a significant challenge in retinal care, and similar to glaucoma, modern therapies are able to slow but not stop disease progression.
This case illustrates the importance of early diagnosis, meticulous imaging interpretation, and patient education in optimizing treatment outcomes.
