In GA Treatment, US Retina Specialists Prioritize Lesion Growth Reduction Over Risks

The doctors surveyed for this study were most likely to treat patients with foveal-threatening lesions and poor VA in the other eye, and they would tolerate higher risks with these patients than with others for a given improvement in lesion growth rate reduction. Risks (particularly wet AMD) and intravitreal injection frequency had a relevant but much smaller impact on decision-making compared with lesion growth rate reduction, which was the main driver of treatment choice. Photo: Paul M. Karpecki, OD. Click image to enlarge. Each patient with geographic atrophy (GA) is unique, as are their visual function deficits. They often present with highly variable visual complaints that range from a minor impact on vision to severe visual impairment that significantly affects activities of daily living and quality of life. Potential GA therapies differ in key characteristics, such as level of efficacy, adverse reaction risks and injection frequency (e.g., ocular gene therapies are being investigated as one-time injections). These differences may impact retina specialists’ treatment preferences and the trade-offs they are willing to make when prescribing treatment for GA.A recent study published in Clinical Ophthalmology assessed the characteristics that influence retina specialists’ treatment preferences in GA and the trade-offs they are willing to make, considering the currently available evidence on possible treatments, pegcetacoplan and avacincaptad pegol. The researchers found that retina specialists were overall willing to tolerate higher side effect risks for increased lesion growth rate reduction or less frequent intravitreal injections (assuming comparable lesion growth rate reduction). Over the ranges used, preferences were most influenced by lesion growth rate reduction, regardless of lesion location or VA in the other eye.By contrast, intravitreal injection frequency was the least important characteristic to retina specialists and less influential on their treatment decision-making than other characteristics, possibly because retina specialists consider intravitreal injections a standard office-based procedure commonly used in wet AMD. However, for comparable lesion growth rate reduction, retinal specialists preferred a one-time injection to a monthly injection, even with some additional risks.The study had US-based retina specialists with seven years or more of clinical experience and who treated 50 patients or over with GA in the previous year select their best and second-best treatment recommendations for specific patient profiles in 12 tasks showing two hypothetical treatment options and no treatment. Treatment characteristics comprised lesion growth rate reduction, three treatment risks (mild-to-moderate uveitis, progression to wet AMD and retinal vasculitis) and intravitreal injection frequency (every month, every other month and one-time [gene therapy]). Patient profiles were defined by GA lesion location and visual acuity. Of 166 retina specialists, 83.1% had experience treating GA with complement inhibitors.The researchers found that improving lesion growth rate reduction from 10% to 50% had the greatest impact on decision-making. Among risks, reducing the chance of progressing to wet AMD from 15% to 1% had the greatest impact (~20% of decision-making). Risk tolerance increased with higher lesion growth rate reduction and, to a lesser extent, with less frequent injections; risk tolerance was highest when considering patients with foveal-threatening GA lesions.“Although the findings should be interpreted in the context of preference research, these results may inform the acceptability of GA treatments to retina specialists and identify factors that might impact risk tolerance and the benefit-risk balance,” the study authors wrote in their paper.“When clinical trial data for gene therapies become available, this study may support assessing whether retina specialists consider observed reductions in the lesion growth rate to outweigh observed risks of wet AMD and uveitis and the need for a one-time intravitreal injection,” they concluded. “Future studies could also explore patients’ preferences for GA treatment and whether they differ from doctors’ preferences.”Click here for the journal source. Csaky K, Pepio AM, Thomas C, et al. US retina specialists’ preferences for geographic atrophy treatment. Clin Ophthalmol. 2026;20:594882. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.