Balancing Anti-VEGF and GA Therapies for Co-Treating AMD and GA in the Same Eye

Dr. Sambhara presents an 87-year-old male with geographic atrophy (GA) in the left eye following vitrectomy and ERM peel who develops new type 1 MNV with mild intraretinal fluid while on pegcetacoplan. The case sparks debate on managing conversion to exudative AMD under complement inhibition—should clinicians pause GA therapy or continue dual treatment? At the roundtable, opinions vary: some defer GA therapy until the exudation stabilizes, while others treat both concurrently. Dr. Sambhara opts for a staggered dual-pathway approach, treating with faricimab for CNV and resuming pegcetacoplan a week later, emphasizing separation for safety, billing, and attribution of potential adverse events. Over 20 months, imaging shows progressive GA enlargement with controlled exudation and stable vision. He emphasizes the importance of informed consent—acknowledging CNV risk—and strong patient education to sustain adherence. Drawing from real-world data, he identifies drivers (poor baseline vision, CNV, and treatment burden) and stresses imaging-based engagement to reinforce that slower loss is still success.