Go through my heart and hope to die, or stick a needle in my eye?


November 17, 2021

1 min read

Biography: Hovanesian is a faculty member at UCLA Jules Stein Eye Institute and in private practice at Harvard Eye Associates in Laguna Hills, California.

Disclosures: Hovanesian does not report any relevant financial disclosure.

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In this issue’s cover story of Ocular Surgery News, we explore emerging treatments for the subset of age-related dry macular degeneration patients with geographic atrophy.

Although this condition affects many more patients than wet AMD – and this number is likely to increase – there are at least three factors that make the treatment of geographic atrophy (GA) different from that of the wet form of this condition. sickness.

1. Patients with GA are harder to find. With wet AMD, most patients are already followed by a retinal specialist and receive treatment by injection. It is easy to take advantage of this population of emerging treatments as they are already seen at least four times a year. In contrast, many patients with GA do not see an ophthalmologist at all, or if they do, their general ophthalmologist or optometrist might be reluctant to refer them to a retinal specialist.

John A. Hovanesian

2. Patients with GA are less motivated. The untreated rate of visual loss in patients with wet AMD is rapid and impossible to ignore. Patients are extremely motivated to avoid progression. Injection therapy, while unpleasant, is accepted even on a monthly basis for nearly a million Americans. In comparison, visual loss with GA is much more insidious, decreasing vision perhaps by one line per year. And the benefit of injecting drugs, according to current studies, can take 6 months or more. Unfortunately, many of these elderly patients with GA will “go through their hearts and hope to die” rather than allowing a doctor to “stick a needle” in their eye.

3. Our best hope is to catch the GA sooner. If we can better identify patients whose first signs of AMD are precursors of GA, these new treatments could be life-changing. Preventing progression to 20/30 is much more exciting than doing it to 20/100. Genetics and other risk stratification efforts may soon help us identify patients at an earlier age, perhaps around the time of cataract surgery, where one can imagine he might one day become the standard of care for performing a risk analysis for the future development of GA.

The availability of revolutionary treatments for GA should generate a lot of enthusiasm in our specialty. While reality may limit their rapid growth, we owe it to patients to find the best candidates and prevent life-changing vision loss as early as possible.


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