Dr. Kitchens: What's changed in identifying and treating GA patients

The management of geographic atrophy (GA) has shifted from a watch-and-wait approach toward early intervention, and identifying the right patients at the right stage remains the central challenge, according to John W. Kitchens, MD, who splits his practice between Retina Associates of Kentucky in Lexington and Rocky Mountain Retina Associates in Boulder, Colorado.

Kitchens said the field’s understanding of GA has evolved rapidly in the roughly three years since therapies became available. Five years ago, GA was viewed as a slowly progressive condition; today, clinicians recognize it progresses faster than previously anticipated, which has changed how—and when—patients are selected for treatment. Kitchens said he now treats a different cohort of patients than when GA drugs first launched, focusing on those with the most vision left to preserve—including patients with foveal-involving GA who still retain useful vision, as well as patients with early GA and good vision who can be monitored over four to six months to document progression. He credited optometrists and referring physicians with increasingly identifying subtle GA earlier using optical coherence tomography (OCT) and autofluorescence imaging.

Framing treatment honestly with patients

Kitchens described his approach to patient counseling as deliberately unpersuasive: he tells patients GA treatment will not restore or improve vision, only slow progression by about 30%, and requires monthly or every-other-month injections. Despite that framing, he said 80% to 90% of patients still choose to proceed once they understand their disease is progressing.

He credited advanced retinal pigment epithelium (RPE) analysis—using tools like Zeiss OCT to show patients how their own atrophy has changed over time relative to their foveal center—as a key driver of that uptake, noting that using a patient’s own imaging to illustrate risk is more persuasive than counseling alone.

Unmet needs: Better treatments, earlier detection

When asked where the greatest unmet need remains, Kitchens pointed to two areas: continued improvement in early identification, and the need for therapies with demonstrated visual benefit.

Current treatments reduce RPE progression by about 30% without showing visual acuity differences versus control groups, a limitation reflected in the GATHER1 (NCT02686658), GATHER2 (NCT04435366), DERBY (NCT03525600), and OAKS (NCT03525613) trial data, he noted.

Emerging therapies on the horizon

Kitchens highlighted two developments he is watching closely. A C1q inhibitor in development at Annexon Biosciences targets photoreceptor synapses rather than complement pathways directly, a mechanism he said may allow researchers to detect a measurable visual acuity benefit, since photoreceptor loss is now understood to precede RPE loss.

Further out, he pointed to cell-based, potentially restorative therapies from Astellas—the company that acquired Iveric Bio, manufacturer of avacincaptad pegol (Izervay)—noting that Astellas has worked on cell-based approaches for a decade and released phase 1 data at ARVO showing a meaningful number of patients gained two lines of vision, promising enough to advance directly to a phase 3 study.

John W. Kitchens, MD

E: [email protected]

Kitchens is in practice with Retina Associates of Kentucky in Lexington and Rocky Mountain Retina Associates in Boulder, Colorado.