Geographic Atrophy Management Consensus (GA-MAC): a Delphi panel study on identification, diagnosis and treatment

• Published in: BMJ open ophthalmology Vol. 8; no. 1; p. e001395
• Main Authors: Kaiser, Peter K, Karpecki, Paul M, Regillo, Carl D, Baumal, Caroline, Ryan, Edwin H, Ip, Michael S, Modi, Yasha, Yeu, Elizabeth, Nijm, Lisa, Farid, Marjan, Rebenitsch, Ronald Luke, Kim, Terry, Shechtman, Diana L, Nichols, Kelly, Schweitzer, Justin, Dunbar, Mark T, Rafieetary, Mohammad R, Donnenfeld, Eric D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.10.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Asymmetry; Atrophy; Longitudinal studies; Macula; Macular degeneration; Medical diagnosis; Medical personnel; Patients; Quality of life; Questionnaires; Retina; Risk factors; Treatment Medical; Vision; United States > US; California
• ISSN: 2397-3269; 2397-3269
• DOI: 10.1136/bmjophth-2023-001395

Background/aimsWith a paradigm shift in geographic atrophy (GA) treatments now available, establishing consensus on the identification and diagnosis of the disease along with considerations for management of patients with GA will assist eye care professionals (ECP) in their day-to-day practices, leading to improved patient outcomes.MethodsA modified Delphi panel process (Geographic Atrophy Management Consensus) consisting of three total surveys and one virtual live meeting held between survey 2 and survey 3. Data were collected from July to October 2022. Participants included expert members of the eye care community that have demonstrated outstanding leadership among peers: a steering committee with three ECPs and a 15-member panel divided between five optometrists, five comprehensive ophthalmologists and five retina specialists. Consensus on statements related to the management of patients with GA was calculated using the RAND/UCLA Appropriateness Method.ResultsAt the conclusion of the third survey, consensus was reached on 91% of the 77 statements. Critical consensus topics include: (1) optical coherence tomography as the favoured method to diagnose and monitor GA, (2) preferred practice patterns regarding referral of patients to retina specialists and (3) treatment criteria given the advent of emerging therapeutics for GA.ConclusionsGenerating awareness of early signs of disease development, progression and identifying the best tools to evaluate GA establishes ideal management and referral strategies. Given the paradigm shift in GA management driven by approved therapies, coupled with the fact that the disease is progressive resulting in devastating vision loss, these strategies are critical to ensure best overall outcomes.