Key Takeaways

In Partnership with Astellas

Geographic atrophy (GA) is advancing into everyday optometric practice—and the timing of what happens after detection matters. In this Four-Eyed Professor episode, Chris Lievens, OD, MS, FAAO, welcomes retina specialist Jessica Haynes, OD, FAAO, to explore how geographic atrophy should be identified, how to talk about it, and when to act. From referral timing to patient counseling around Izervay (avacincaptad pegol) and other complement inhibitor therapies, they share a clinic-tested approach that helps clinicians protect vision now while preparing patients for what’s next.

Geographic atrophy awareness is growing thanks to consumer campaigns, but many patients still arrive unfamiliar with the term. Dr. Haynes recommends using the exact diagnosis—geographic atrophy—instead of only euphemisms like “blind spots” or “degeneration.” Naming the disease validates the condition, provides patients with language to research resources, and ensures consistency when transitioning to ophthalmology referral.

Action in clinic: Use “geographic atrophy” in your first two sentences. Then add a plain-language anchor: “GA is an advanced stage of dry macular degeneration where patches of retinal tissue thin and stop working.”

The first appointment often determines long-term adherence. Dr. Haynes’s approach:

Actionable script:
“Today is about understanding geographic atrophy, how we monitor it, and what options exist to protect vision over time. I’ll give you a short guide to review at home. We’ll regroup soon to discuss questions and next steps.”

The profession has long labeled GA as “slowly progressive,” breeding a habit to monitor without momentum. Two traps stand out:

Implementation pearls

For Izervay (avacincaptad pegol) and other complement inhibitor therapy options, precision in messaging is critical:

Izervay mechanism of action
Izervay works as a complement C5 inhibitor. By blocking part of the overactive complement pathway, it reduces the inflammatory cascade thought to accelerate retinal cell death in GA. Simplifying the science helps patients see why monthly or bimonthly injections matter for protecting their remaining vision.

Optometrist–Ophthalmologist teamwork
When optometrists and ophthalmologists collaborate effectively, patients benefit most. If a patient appears hesitant, the optometrist can schedule a brief “expectations visit” after the ophthalmology consultation to revisit goals and logistics. This coordinated approach ensures patients feel supported across both providers, reinforces consistent messaging, and improves treatment adherence with therapies like Izervay.

When patients ask, “What’s the best time to begin?” Dr. Haynes offers a memorable principle:
If the system has been “faulty” for years, the ideal time to inhibit the pathway would have been long ago; the next best time is now.

Why timely action matters:

Clinical takeaway: If imaging and function suggest candidacy, a proactive referral and decision pathway today beats reconsidering after another 6–12 months of enlargement.

Geographic Atrophy Action Pathway (Clinic SOP)

Dr. Haynes emphasizes authentic care over perfect phrasing. Patients sense intent. To avoid tipping into fear:

Actionable language to borrow

For optometrists, owning the first conversation on geographic atrophy and building a quick, respectful path to ophthalmology referral is now core care. When clinicians name GA clearly, show progression visually, set expectations for Izervay (avacincaptad pegol) therapy, and pace decisions without pressure, more patients choose—and stick with—treatments that protect function over time. The right time to act is the patient in your chair today.