Gap #1: Due to the novelty of available treatments, clinicians may not be aware of the necessity of early treatment for GA.

Learning Objective #1: Understand the variability in speed of progression of GA, recommended screening techniques, and the benefits of early treatment.

Given the novelty of intravitreal complement inhibitors for treatment of GA, ophthalmologists and optometrists may not be aware of the need to refer for treatment early to prevent irreversible vision loss. Although the complement inhibitors show promising results for slowing the progression of GA, they do not reverse atrophy that has already occurred and cannot restore vision that has already been lost.¹⁵ Thus, early diagnosis and treatment referral are key.

Historically, GA may have been understood by some clinicians to be a slowly progressing condition as compared to neovascular AMD.¹⁶ In reality, GA progresses at variable rates, with lesion noncentrality, multifocality, intermediate baseline size, and bilaterality all being associated with faster progression.³Among patients with non-central GA, 57% progress to involve the fovea within 4 years.³ When this occurs, the resulting central vision loss is often sudden and devastating.¹⁶ However, a recent survey was conducted of 81 injecting ophthalmologists, 50 non-injecting ophthalmologists, and 50 optometrists.¹⁷ Only 54% of the optometrists surveyed believed that there was an unmet need for treating patients with GA, compared with 84% of the non-injecting ophthalmologists and 86% of the injecting ophthalmologists.¹⁷ This highlights the need for further education of all types of eye care providers.

“Time matters for these patients, so we want [referring providers] to know that this disease progresses fast, and that for the first time we have therapies that we can intervene and affect the rate for that patient’s vision loss,” said David R. Lally, MD, director of the Retina Research Institute at New England Retina Consultants.¹⁶

Prior to the approval of pegcetacoplan in 2023, the standard of care for GA was lifestyle intervention, the age-related eye disease study 2 (AREDS2) dietary supplement, and monitoring for the development of neovascular AMD.¹⁸ These interventions do not necessarily require timely referral to a specialist, so a need for early referral for treatment likely represents a significant change in established patterns. Accordingly, in the above survey, only 32% of non-injecting ophthalmologists and 36% of optometrists reported that they would typically refer a patient with GA for treatment within the first month of diagnosis.¹⁷

In addition, a lack of clear recommendations for screening techniques may delay diagnosis in some cases.¹⁹ In the past, fundus autofluorescence and color fundus photos were often used to diagnose GA.¹⁵ However, with recent advances in ophthalmic imaging techniques such as high-resolution optical coherence tomography (OCT), better methods are now available.¹⁵ “We feel that OCT is best because it allows 3D and high-resolution imaging to diagnose atrophy more accurately,” Dr. Lad stated.¹⁵

Gap #2: Clinicians may not be aware of the results from recent phase 3 clinical trials of complement inhibitors in patients with GA.

Learning Objective #2: Understand and describe the key results from recent phase 3 clinical trials of the complement inhibitors pegcetacoplan and avacincaptad pegol in patients with GA.

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