Podcast: Play in new window | Download
Subscribe: Apple Podcasts | Google Podcasts | Spotify | Amazon Music | Android | RSS
On this week’s episode, the Defocus Media team discusses rewriting the geographic atrophy conversation with IZERVAY. Join us in an engaging podcast episode where Dr. Jennifer Lyerly engages with esteemed eye care experts, Dr. Cecelia Koetting and Dr. Darryl Glover, to discuss groundbreaking treatments for Geographic Atrophy and Dry Age-Related Macular Degeneration. Dr. Koetting, practicing in Denver, CO, and renowned for her expertise in neuro-optometry and ocular surface disease, alongside Dr. Glover, delves into the latest FDA-approved medications, patient communication strategies, and the importance of collaborative eye care. This episode offers valuable insights for eye care professionals on how to have an AMD and geographic atrophy conversation.
Editorially Independently Sponsored by Iveric Bio, An Astellas Company. Iveric Bio had no control over the content of this piece.
Table of Contents
Dr. Jennifer Lyerly:
Dr. Koetting, I’m eager to hear about your professional journey since we graduated from The Southern College of Optometry. You’ve had quite an exciting career. You’ve been particularly busy over the last couple of years, haven’t you?
Dr. Cecelia Koetting:
Yes, indeed. After graduation, I completed my residency in Cincinnati at the VA. Following that, I briefly worked in Tucson for about a year. Then, for nearly a decade, I was in Virginia at a referral center, Virginia Eye Consultants, closely collaborating with ophthalmologists. My focus was primarily on eye diseases, which we humorously referred to as my “tenure fellowship.” It was an extraordinary experience. More recently, about two years ago, I relocated to Colorado and joined the University of Colorado School of Medicine. Here, I continue my specialization in eye diseases, particularly ocular and neurological disorders, but I also handle a variety of cases, as most of us do.
Dr. Jennifer Lyerly:
That’s intriguing. Are you involved in teaching, and what does your current position entail?
Dr. Cecelia Koetting:
Currently, I’m not teaching, but I hope to in the future. In Virginia, I served as both the extern and resident director at Eye Consultants, and I’m aiming to introduce similar opportunities for aspiring optometrists at the University of Colorado. Interestingly, our staff optometrists teach the ophthalmology residency program, which I think is quite remarkable.
Evolution of Patient Conversations Around Dry Age Related Macular Degeneration
Dr. Jennifer Lyerly:
That’s fascinating. Today, we’ll delve into a significant topic in medicine, specifically the new treatments for macular degeneration and geographic atrophy converstations. Before we start, I want to extend my gratitude to Iveric Bio an Astellas company for supporting this podcast episode. Please note that this is an independent podcast, and the views expressed are purely our own. We’ll be sharing our unique perspectives on optometry and geographic atrophy. With the recent FDA approval of medications for treating geographic atrophy and dry macular degeneration, how have your geographic atrophy conversations evolved regarding dry AMD?
Dr. Cecelia Koetting:
Absolutely, with dry AMD, our advice used to be quite basic: eat leafy greens, avoid smoking, wear sunglasses, and use the Amsler grid. At a certain stage, we would discuss AREDS formula vitamins. It was more about monitoring and referring when necessary. However, with dry AMD, there’s always been the risk of progression to geographic atrophy or worsening macular degeneration. Now, with the availability of treatments for geographic atrophy, the geoghraphic atrophy conversation has shifted. I find myself informing patients, especially those with signs suggesting a higher risk of developing geographic atrophy, that there are now viable treatment options for dry macular degeneration that progresses to this condition.
Dr. Darryl Glover:
It’s crucial to consider the quality of life for these patients. When they come to us, it’s not just about the clinical aspects, but how these conditions and treatments impact their daily lives.
Dr. Jennifer Lyerly:
I’ve noticed a significant shift in my own approach. Previously, with macular degeneration, I focused mainly on looking for choroidal neovascularization (CNV) and categorizing patients as either having it or not. I’ve realized that I wasn’t paying enough attention to geographic atrophy. To properly identify it, one must think differently. I’ve had to adjust my mindset to actively look for geographic atrophy, making more use of fundus autofluorescence photos and rethinking how I interpret OCTs. This requires continuous effort and a philosophical shift in our approach to eye care. We must rewrite our AMD and geographic atrophy conversation.
Dr. Cecelia Koetting:
You’re right, and it’s a manageable change. It’s not so drastic that it’s beyond our capabilities, even for those of us who aren’t retina specialists. I’m not a specialist in this area either, but I’m still vigilant in looking for these signs. What I want to emphasize is that this is well within our scope. We can have these discussions and make referrals based on the potential for treatment. We don’t have to make promises, but we can offer hope and direct our patients towards these new possibilities in treatment.
Preserving Vision in Patients with Geographic Atrophy
Dr. Cecelia Koetting:
It’s crucial for us to communicate to our patients that our goal is to preserve their current vision, especially for those who have already begun to experience vision loss. When geographic atrophy is diagnosed, we generally see a decline in vision within about 2.5 years on average, though this varies from person to person. We need to inform patients that our objective is to prevent further deterioration. While we currently don’t have a means to reverse or improve vision loss, we aim to provide every opportunity to maintain their existing vision.
Dr. Jennifer Lyerly:
That’s an excellent perspective. In my practice, I’ve been framing this similarly to how I discuss glaucoma: with a focus on preserving and protecting. My goal is to maintain the patient’s current vision for as long as possible and to slow any future vision loss.
Communicating Treatment with IZERVAY Efficacy and Expectations
Dr. Jennifer Lyerly:
Dr. Koetting, could you share some tips on how to effectively communicate the importance of this treatment to our patients? How do you have a geographic atrophy conversation?
Dr. Cecelia Koetting:
Certainly, the approach is similar to discussing glaucoma. We need to express our concerns clearly when we see signs that indicate potential vision loss. It’s important to emphasize the chronic, long-term, and progressive nature of the condition. Use language that resonates with patients, highlighting the risk of vision loss, which can significantly impact their daily functioning and quality of life. As their doctor, our role is to optimize their chances of preserving and protecting their vision. This involves not just recommending leafy greens and vitamins but also referring them to a retina specialist to determine the stage of their condition and whether they could benefit from specific treatments.
Dr. Jennifer Lyerly:
Speaking of treatment effectiveness, study data shows a 35% reduction in the progression of geographic atrophy in the first year. The lesions still grow, but at a slower rate. How should we define and communicate success to our patients, considering they may still experience some growth in geographic atrophy and vision changes?
Dr. Cecelia Koetting:
Honestly, in practice, I usually don’t delve deeply into the specifics of treatment efficacy with my patients. That’s a conversation better suited for a retina specialist. However, it’s important for us as primary care providers to be informed because patients often ask us for advice, trusting our long-standing relationship with them. When asked about the effectiveness of treatments for geographic atrophy, I reference the studies showing up to a 35% reduction in lesion growth in the first year. The second-year data indicates a 15 to 19% reduction with monthly or bi-monthly treatments. These numbers might seem modest, but they’re significant. If I were in the patient’s position, or if it were my family member, I would want to take every possible measure to prevent vision loss. We advise patients to eat healthy, avoid smoking, and wear sunglasses, which offer less quantifiable benefits. So, why wouldn’t we discuss this potential treatment option? It’s important and imperative to have the AMD and geographic atrophy conversation.
Dr. Darryl Glover:
Patients today are well-informed and often research their conditions before consultations. If we don’t initiate these discussions, they’ll likely seek information elsewhere, like online or through personal networks. It’s crucial to stay updated on the latest treatments and approach each case as if it were a loved one. Failing to do so is a disservice to our patients. It’s about preserving vision and acknowledging the serious impact of the disease.
Dr. Jennifer Lyerly:
There’s a moral and ethical imperative to inform patients about available treatments and facilitate timely referrals. When considering geographic atrophy, which is likely to progress and cause significant vision loss, we shouldn’t hesitate to recommend treatments with proven efficacy. For instance, we commonly recommend AREDS 2 vitamins for intermediate dry macular degeneration, despite their lower progression reduction rate. Given that the new treatments for geographic atrophy show even higher efficacy and address a more severe form of the disease, discussing them is undoubtedly essential. It’s about more than just statistics; it’s about preserving our patients’ independence, like their ability to drive or read.
Dr. Cecelia Koetting:
Moreover, we should consider the broader implications of vision loss, such as its impact on mental health and overall well-being. When patients start losing independence and their ability to perform daily tasks, it significantly affects their mental health, which in turn can lead to physical health deterioration. It’s not just about preserving sight; it’s about maintaining quality of life. Please have a geographic atrophy conversation.
Building Relationships with Ophthalmologists through Geographic Atrophy Conversations
Dr. Cecelia Koetting:
Absolutely, the discussion about the relationship with ophthalmologists is vital. Throughout my career, working alongside ophthalmology has been incredibly beneficial. The ability to learn from and collaborate with specialists has enriched my practice immensely.
Dr. Darryl Glover:
I completely agree. I often refer to myself as the ‘referral king’. I have a great relationship with my retina specialist, Dr. Bennett at NC Retina. Whenever I encounter a challenging case, I can quickly reach out to him, and he’s very responsive. This relationship has been built over time and is invaluable. The specialists often send back detailed notes, which helps me review my assessments and learn from them. It’s almost like a game, trying to ensure that my diagnoses are accurate. It’s important not to hesitate or feel nervous about referrals. Failing to act or delaying could lead to a patient’s condition worsening significantly.
IZERVAY Clinical Trial Data and Side Effects
Dr. Jennifer Lyerly:
That’s an excellent point. Now, let’s delve into the GATHER clinical trial data. Could you share insights on the most common side effects observed during the trial? I beleive it’s important to have this information when having a geographic atrophy conversation.
Dr. Cecelia Koetting:
The most common side effects observed in the trials are typical of those associated with eye injections, which many of our patients already experience due to treatments for conditions like diabetic retinopathy or wet macular degeneration. These include subconjunctival hemorrhage at the injection site, which, while unsightly, is transient. Another noteworthy side effect was a temporary increase in intraocular pressure, observed in about 9% of patients. This is particularly relevant for patients with glaucoma, as their medication regimen might need adjustment around the time of injections. Blurred vision was reported in 8% of cases, likely related to vitreous floaters post-injection.
On the rarer side, there were instances of endophthalmitis, with a very low incidence rate of 0.05%. The risk of retinal detachment was between zero to 0.7%. These risks are inherent to any procedure involving penetration of the globe. Regarding concerns about intraocular inflammation with new drugs, the companies are vigilant, especially now as more patients are receiving these injections.
The two-year data showed an approximate 7% risk of choroidal neovascularization in the treatment group during the first year, compared to the sham group. By the second year, the risk was found to be similar between treated and untreated groups. This indicates that some patients might be inherently at a higher risk of developing wet AMD, and researchers are trying to identify these patients.
