• Geographic atrophy requires equally strong clinical and emotional support, and early conversations rooted in empathy can reduce patient fear and uncertainty.
• Advanced imaging and clear education about progression help optometrists detect GA early and guide patients through tough decisions about treatment, including candid discussions of complement inhibition options like Izervay.
• Caregiver involvement is essential, as most GA patients rely on family for transportation, follow-up, and long-term management.

Vision loss is never a purely clinical journey. As Dr. Jennifer Lyerly shares at the start of this Defocus Media episode, geographic atrophy affects patients emotionally, socially, and psychologically. Optometrists, therefore, play a central role in offering meaningful support throughout the entire geographic atrophy experience—especially as new treatment options, including Izervay, enter the landscape.

In this episode, Dr. Lyerly is joined by retina-focused optometrist Dr. Sarah LeMay, her classmate and colleague, to discuss how to guide patients with geographic atrophy, how to communicate about disease progression, and how to bring empathy and clarity into every visit.

Many patients arrive believing there is a “good” type of macular degeneration and a “bad” type. Dr. LeMay explains that the terms “dry” and “wet” often lead to confusion, especially because geographic atrophy is an advanced form of age-related macular degeneration (AMD), even though it falls under the “dry” category.

Patients often panic when they hear “macular degeneration.” They often recall loved ones who lost significant vision and assume their outcome will be the same. Dr. LeMay stresses that one of her most important responsibilities is helping patients unlearn these misconceptions and understand where their disease truly falls on the spectrum.

Fear is the defining emotion Dr. LeMay sees when diagnosing or monitoring patients with AMD and GA. She referenced data from a large international geographic atrophy insights study:

• 70% of GA patients rely on a caregiver
• 46% experience anxiety
• 39% report feeling powerless

Dr. LeMay uses this information to validate patients’ feelings and remind optometrists of a critical truth: GA patients need emotional support as much as clinical expertise.

Dr. Lyerly notes that doctors must be ready to have these heavy conversations, because GA discussions can escalate from mild concern to life-altering realities like the loss of legal driving vision.

Two-thirds of GA patients present with extra-foveal lesions, meaning they can still read well on a Snellen chart. But subtle symptoms emerge:

• Reading takes longer
• Night driving becomes difficult
• Contrast sensitivity decreases
• A “something isn’t right” feeling

These can be dismissed as normal aging unless the clinician performs detailed macular imaging. Dr. LeMay uses:

• OCT
• Autofluorescence imaging
• Ultra-widefield imaging

She often shows patients the lesion’s location relative to the fovea and uses the powerful analogy that GA grows approximately the size of the optic nerve head each year on average. This helps patients visualize urgency without inducing panic.

Dr. Lyerly and Dr. LeMay discuss the delicate balance between not terrifying patients and not underselling the seriousness of GA.

Dr. LeMay’s communication approach includes:

1. Honest Expectations

She explains:

• GA is not reversible
• Vision will not improve
• Treatment focuses on slowing progression, not curing it

2. Introducing Low Vision Early

Dr. LeMay offers:

• Low vision contacts
• Audiobook and large-print resources
• Transportation services
• Councils for the blind

This empowers patients instead of waiting until they feel helpless.

3. Calmly Discussing Treatment Options, Including Izervay

When discussing complement inhibition options (including Izervay, referenced in the transcript during the GATHER study discussion), Dr. LeMay explains:

• Candidates are usually extra-foveal GA patients
• The goal is to slow lesion growth, especially before reaching the fovea
• Complement inhibition can reduce growth rates by 20–35%, depending on clinical data
• Results help preserve meaningful vision longer, even though disease progression continues

4. Taking Time Before Initiating Treatment

She never signs patients up for injections on their first visit. Instead:

• She provides educational handouts
• Encourages discussion with family
• Schedules a follow-up visit
• Revisits imaging to show growth or stability

GA is slow-moving, so patients have time to process and decide.

Dr. LeMay explains that all intravitreal injections have rare but serious risks:

• Endophthalmitis
• Retinal detachment
• Vitreous hemorrhage

With complement inhibitors, additional concerns include inflammation and vasculitis. Her clinic paused recommending these treatments briefly when real-world cases emerged, but later resumed with caution—often injecting the worse-seeing eye first.

Patients are instructed to monitor any changes in pain or vision closely and call immediately if symptoms arise.

Because most GA patients rely on caregivers, Dr. LeMay encourages family members or caregivers to attend visits.
She is transparent about:

• Driving capability changes
• Medication reading difficulties
• Managing mail and daily tasks
• Transportation demands for injection visits

When caregivers understand the disease and expectations, patients feel supported and engaged rather than overwhelmed.

She also brings up Charles Bonnet syndrome early in advanced cases, reassuring patients that visual hallucinations are not a sign of dementia but a known response to central vision loss.

Dr. LeMay offers clear guidance for clinicians:

• Stay current with GA literature and treatment expectations
• Listen deeply to patient descriptions of visual changes
• Use imaging proactively—especially OCT and autofluorescence
• Introduce low vision resources early
• Coordinate closely with your local retina specialists
• Structure your exam so patients feel fully heard, even with a busy schedule

As Dr. Lyerly notes, patients do not remember every clinical detail, but they always remember how the doctor made them feel.

Dr. Lyerly takes a moment in the episode to acknowledge Izervay for supporting this important conversation, enabling a nuanced discussion about geographic atrophy, complement inhibitors, and the emotional needs of GA patients. Their support helps ensure clinicians feel confident in recognizing GA and guiding patients with compassion.

Geographic atrophy demands a care model rooted in empathy, education, and partnership. Through their conversation, Dr. Jennifer Lyerly and Dr. Sarah LeMay remind us that optometrists are uniquely positioned to guide patients through every stage of the journey—from subtle early symptoms to discussions about imaging, low vision, complement inhibition, and treatment options such as Izervay.

By listening closely, involving caregivers, and communicating clearly, eye care professionals can help patients preserve not only their remaining vision, but also their confidence, independence, and emotional well-being.