Results of a Delphi consensus study of geographic atrophy (GA) diagnosis and current management

Abstract

Purpose : With emerging therapies for GA, little is known about how GA is evaluated. A Delphi survey was conducted to determine consensus among healthcare professionals (HCPs), specifically retina specialists, on GA diagnosis and management.

Methods : Initial consensus was developed by 8 retina specialists, serving as a steering committee, with an electronic questionnaire (round 1) sent to 175 randomly selected retina specialists globally. In round 2, 125 HCPs (selected from the same respondents) were probed further on question areas that did not achieve consensus in round 1. Questions were open ended, multiple choice, rank order, level of agreement (Likert scale). Consensus (defined as ≥75% agreement for a response) was sought in areas relating to GA diagnosis and current patient management.

Results : Reading difficulties (93% agreement) and impaired ability to recognize faces (84%) are the most elicited symptoms during an initial clinical visit by HCPs. The most often used functional measures for GA are best corrected visual acuity (94%) and the Amsler grid (86%). Optical coherence tomography (OCT) is the most regularly used imaging modality (98%), followed by fundus autofluorescence (81%), and color fundus photography (77%). OCT was ranked as the first or second most important imaging modality (out of 6) for GA diagnosis and monitoring by 85% and 82% of HCPs, respectively. There is consensus among HCPs (76%) that foveal involvement is the most important variable for determining GA prognosis. Impact on daily living (89%) and visual-aid options (75%) are important topics to discuss with newly diagnosed patients. Most (90%) felt a GA treatment option would have a significant positive effect on patient quality of life. Low vision aids (90%), smoking cessation (86%), and vitamin supplementation (75%) are thought to be beneficial for GA. Active neovascular age-related macular degeneration (in either eye) was selected as the most common circumstance requiring a patient with GA to be followed more closely (76%). Most (82%) of HCPs agreed that patients with choroidal neovascularization controlled by anti-vascular endothelial growth factor therapy can continue to experience vision loss due to atrophic lesions.

Conclusions : There was agreement among HCPs that GA is a significant burden, meriting close management. In lieu of treatment options, HCPs also agreed on general clinical management approaches.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.