Closing the distance gap in GA treatment retention

Could something as simple as distance to the clinic affect whether patients stay on treatment? A recent analysis of patients receiving complement inhibitor therapy for geographic atrophy (GA) secondary to age-related macular degeneration (AMD) found that every 10-mile increase in distance from the treating clinic was associated with a 14% increase in the odds of loss to follow-up.¹ The findings, presented as a poster at the 2026 Women in Ophthalmology Summer Symposium, highlight access and treatment burden as key factors shaping whether patients continue GA therapy over time.

In this Q&A conversation with Ophthalmology Times (OT), Reem Amine, MD, a postdoctoral research fellow at Duke Eye Center in Durham, North Carolina, discusses her findings, what they suggest for improving patient retention in retina practices, and where she sees the field heading next.

Note: The transcript has been edited lightly for clarity and length.

OT: Your study looked at factors associated with loss to follow-up in patients receiving complement inhibitor therapy for GA secondary to advanced AMD. Of the factors you identified—whether that is treatment burden, distance to clinic, socioeconomic factors, or something else—which one surprised you most, or which had the strongest effect size?

Reem Amine, MD: The finding that stood out to me most was the association between distance from the clinic and loss to follow-up as an outcome. We found that every 10-mile increase in the distance from the clinic is associated with a 14% increase in the odds of being lost to follow-up. It was not necessarily surprising because we know patients really need repeated visits and injections over a long period of time when it comes to this disease. So, I think this really highlights that when we think about the success of complement inhibition, we cannot think of efficacy and safety only. We also need to think about access and whether patients can realistically sustain the treatment.

OT: GA treatment with complement inhibitors requires a real commitment—frequent injections with a slower, less visible benefit than anti-VEGF therapy for wet AMD, since you are slowing progression rather than restoring vision. How much of the loss-to-follow-up problem do you think is specific to that GA treatment experience vs general barriers we already see across chronic retinal disease?

Amine: I think it’s both. Some of the factors we identified, like the distance from the clinic—there are different demographic variables—they are general barriers that we see across different chronic retinal diseases. However, GA probably adds another challenging layer because the benefit is less tangible than for patients who are receiving anti-VEGF, obviously. So, patients may question the value of continuing these injections, and they don’t feel much difference at the vision level. But I think that expectation-setting and counseling the patient at the beginning of treatment is particularly important when it comes to this disease, alongside addressing, of course, the practical barriers like transportation and distance.

OT: Based on your findings, what is one practical change a retina practice could make tomorrow to improve retention in patients with GA on complement inhibitor therapy—whether that is how the therapy is counseled at consent, scheduling, reminder systems, or something else?

Amine: I think one thing I would implement, or it makes sense to implement, is a standardized retention checklist at the beginning of initiating the therapy. So, patients at, let’s say, higher risk for loss to follow-up—particularly those who live farther from the clinic or cannot access care—could be flagged up front, with proactive scheduling reminders, and things like that. The key here is to intervene before the patient gets lost to follow-up, rather than trying to recover them after we lose them.

OT: Loss to follow-up often disproportionately affects patients with less access to transportation, flexible work schedules, or caregiver support. Did your data point to any specific GA populations that are most at risk of falling out of care with these therapies?

Amine: There are a lot of factors in play here. Our population, or the population of this study, was mostly patients who lived farther away from the clinic. The distance in particular was independently associated with loss to follow-up. We did not really study or capture specific factors like transportation, work flexibility, or caregiver support; these are great points to consider and look into more, [but] we can’t speak about them from my study’s point of view. However, I think our findings highlight the importance of identifying patients with access, or potential access barriers, early on, and then, potentially prospectively, we can look more into the social determinants in future studies.

OT: With everything happening in retina right now, what is the one thing you think is not getting talked about enough?

Amine: I think this is all good research that we are privileged to conduct at Duke Eye Center. One thing I would really look at in the future—and this is something I'm actually also studying in other projects, but would like to implement here—is incorporating more AI [artificial intelligence] tools into everyday retina practice. Retina is really advancing incredibly quickly, with all the gene therapies and imaging technologies. I think AI can potentially be an aiding tool in that and can allow us to detect diseases earlier, monitor progression, and personalize treatment. So, using AI thoughtfully to help deliver those therapies more effectively, and to identify patients who may be at risk of falling out of care, is incredibly important for the practice of retina and ophthalmology in general.

I would say there is a gap between what retina really has technologically and what is sustainably delivered to the patient. This is definitely a work in progress. There are different therapies coming up and different imaging technologies. But as I mentioned, having AI as part of this whole system, and incorporating AI tools, is something really important that we need to make use of—not just developing the tools, but also incorporating them into clinical practice so we can really benefit from them. It’s a huge thing to be considered.

Reem Amine, MD
E: [email protected]
Amine is a postdoctoral research fellow at Duke Eye Center in Durham, North Carolina.

Reference

1. Amine R. Factors associated with loss to follow-up in patients receiving complement inhibitors for advanced age-related macular degeneration. Poster presented at: Women in Ophthalmology Summer Symposium; August 20-23, 2026; Monterey, CA.