EPISODE 20: Diana Do, MD, interviews Evan Dunn, MD, about how he diagnoses geographic atrophy in patients, and then educates them on treatment plans and expectations of vision protection.
What follows is a lightly edited transcript of the conversation:
Diana Do, MD: Welcome to the Geographic Atrophy Video Channel. I'm Dr. Diana Do, and today I have the pleasure of discussing challenging GA conversations with Dr. Evan Dunn, retina specialist. Thank you, Dr. Dunn, for joining us.
Evan Dunn, MD: Diana, thank you so much for having me.
Dr. Do: Geographic atrophy (GA) is the advanced form of age-related macular degeneration, and we often encounter patients with GA in our clinic. How do you diagnose GA when you encounter a patient with AMD?
Dr. Dunn: Right. So I think the primary way that we're all diagnosing GA with our patient at our side is with fundus autofluorescence (FA) and highlighting those areas of hypo-autofluorescence and showing it to our patients.
Dr. Do: Great. And then now when we are encountering patients with GA, we do have FDA-approved therapies such as complement inhibitors. How do you discuss this therapeutic option with your patient?
Dr. Dunn: Yeah, that's a great question. So I always recommend complement inhibitors based on their safety and other efficacy, but I think before taking the deep dive into which complement inhibitor we're going to use and if we're going to do it, it really starts with patient education and getting them on board.
So the way that I go about doing it is I show patients their FA. I highlight all of the areas that are hypo-autofluorescent, and I show them that these are the areas that are threatening their vision. I explain to patients that they can think of their retina like the film in a camera, and they can think of their retina almost like a garden. There's two main problems you can have in your garden. You can have weeds growing in your garden, or you can have brown patches of grass. And in the retina, you can get these brown patches of cells or parts of their cells that are less healthy, and these cells can expand in size and can become threatening to the area of central vision or can begin to decrease their areas of central vision.
I then highlight these areas of hypo-autofluorescence on the FA, and I show them the areas that may be threatening their vision and how our goal is to try to slow the progression or potentially stop the progression.
Dr. Do: I think that's a great way of making this disease more relatable using that analogy of the garden, Evan. And the whole concept of complement inhibitors, as you mentioned, is to slow the progression. So how do you explain that this is not going to improve the vision, but yet you're simultaneously trying to preserve or slow down what vision they have left?
Dr. Dunn: That’s a really good point. Patients want to start a therapy that they think is going to improve their vision, so I think it's really, really important to make them aware that the way that they're seeing today is the best they're ever going to be able to see with our current therapeutic options. So what we're doing is we're not fighting to improve their vision, we're fighting to preserve their vision, and they need to be on board with that message.
Dr. Do: And of course, if we employ complement inhibitors, they do require frequent even every 1 to 2 months at certain intervals and maybe going on for years or the rest of their life. How do you keep them engaged in continuing their therapy and being compliant?
Dr. Dunn: Yeah, that's a great point. I think we're really fortunate to have wonderful widefield imaging where we can show patients that maybe every 3 or 4 months in my practice when I perform FA, we can compare their images, we can hopefully show that we've slowed or decreased progression, and patients really are excited to see their images and hopeful for optimistic results. And I think that really keeps them on board and makes them want to continue with the treatment.
Dr. Do: I think that's a perfect way to educate them, with actual visual evidence from their own eyes. And if you started complement inhibitors, do you often treat both eyes if they're both involved on the same day?
Dr. Dunn: I typically do in my clinical practice. There is a small percentage of patients who prefer to just have 1 eye done, but I usually do both.
Dr Do: Well, thank you so much for sharing these insights and I've learned a lot from how you practice and I look forward to future discussions.
Dr. Dunn: Thank you so much for having me.
