Enhancing the Patient Journey: Solutions for Effective GA Management
Emerging treatments to slow down geographic atrophy (GA) progression are now making it possible for patients to sustain functional vision for longer. With a global increase in the aging population, 2040 will see 18.57 million GA cases worldwide. For clinicians, this can mean an 8-10% increase in clinic caseload. Early changes in the retinal layers can already signal the impending atrophic change, making it possible for specialists to plan ahead and treat early.
Professor Ursula Schmidt-Erfurth
“GA treatment is a huge breakthrough, but the clinician needs to be able to manage this efficiently. Availability in the US is making a significant impact to millions of lives,” explains Professor Ursula Schmidt-Erfurth, Chair of the Department of Ophthalmology and Optometry at the Medical University of Vienna.
Read the complete story on managing GA patients efficiently with limited resources.
The Heidelberg Engineering Ecosystem of solutions aligns with the needs of patients and supports clinicians with an array of precise, accurate, and comprehensive diagnostic data and monitoring tools, efficient data management, and outstanding image quality. These tools fit nicely with primary and specialist caregivers to deliver early detection, timely referrals, and confident diagnostic decisions. Find out how retina experts globally are improving the quality of life for GA patients.
Initial Assessment and Ongoing Treatment
Heidelberg Eye Explorer HEYEX EMR ophthalmic electronic medical record enables complete electronic documentation of the patient journey. All patient information is centrally located and can be accessed from anywhere in the clinic. Images and data are immediately available on the desired device, viewing station, and in the patient record. Further, HEYEX EMR allows the clinician to manage the entire patient journey by providing effective visualization of treatment delivery and functional outcomes over time.
Prof. Oliver Findl (left), Chairman of the Department of Ophthalmology at Hanusch Hospital (Vienna, Austria), and Dr. Christoph Hackl, Consultant Ophthalmologist and Clinical Project Lead for the HEYEX EMR implementation
“In our retina and injection clinic, we have the ubiquitous challenge of ensuring adequate care for the increasing number of patients who need regular injections, in addition to the other retina clinic patients. The number of injections we give has increased by more than 15% per year over recent years. We have always tried to improve our processes to provide the best care to our patients.” – DR HACKL, Hanusch Hospital, Vienna.
Read more on how Hanusch Hospital, Vienna, improved their patient care processes with HEYEX EMR.
Early Detection of Geographic Atrophy
Christopher Mody
“Dry AMD is five times more prevalent than Wet AMD, and clinicians need to catch patients early. First signs of the condition may be problems with night vision and contrast sensitivity. The recent AREDS study quotes 2.5 years as the mean time for GA to have foveal involvement, and that GA will account for 35 percent of advanced AMD.” CHRISTOPHER MODY, Ophthalmic Scientist and Clinical Director - Heidelberg Engineering.
Read what clinicians and experts recommend for GA patient management with limited resources.
Signs of early GA can include subretinal drusenoid deposits, drusen, and pigmentation changes in the RPE. The Classification of Atrophy Meeting group (CAM), a body of leading experts in the field of AMD, recommends use of OCT supported by cSLO imaging for atrophy detection. Multimodal imaging is therefore crucial in identifying features consistent with early geographic atrophy and its differential diagnosis.
The SPECTRALIS® platform enables precise and reliable outcomes in GA patient management. Spectral-Domain OCT technology enables higher axial resolution, for observation of the inner retinal layers more precisely. Confocal Scanning Laser Ophthalmoscopy technology allows unmatched image quality to pinpoint pathology, even in the most challenging patients, critical for making early and confident diagnostic decisions. The patented TruTrack Active Eye Tracking together with AutoRescan, minimizes motion artifacts and allows follow-up scans in precisely the same anatomic location as previous exams to detect and monitor change over time.
Learn from renowned retina specialist Jeremiah Brown, MD, Founder of Retina Consultants of Texas, as he educates on identifying signs of early GA with OCT, applying the power of multimodal imaging to map and track dry AMD and educate patients on the disease (Video 1).
Confident Diagnostic Decisions
Ruling out masqueraders, confirming a differential diagnosis, and determining subsequent RPE degeneration are critical decisions when identifying and managing a GA patient.
Each imaging technique in a multimodal workflow offers different insight into a particular aspect of retinal pathophysiology by reflecting the health of a certain component of the retinal tissue. Combining multiple imaging techniques helps form a complete picture of the patient’s condition, from the baseline to disease progression.
A color fundus photo provides documentation of the retinal appearance. Imaging with SPECTRALIS MultiColor Module (Image 2, 5) can provide additional pathological information from different depths of the retina.
Blue autofluorescence imaging (Image 3, 6) is a useful marker for determining the metabolic health and associated risks to the RPE. Areas of hyper autofluorescence give further indications of lesion progression. Harness the power of blue laser autofluorescence with SPECTRALIS BluePeak Module.
OCT Angiography is faster and sharper on SPECTRALIS with SHIFT technology, which captures OCTA scans at 125 kHz for a better clinical workflow. SHIFT technology also allows OCT imaging at 20 kHz for patients with media opacities and small pupils.
Image 1: SPECTRALIS® simultaneous IR Reflectance and OCT - Sub-retinal drusenoid deposits and early hyper-transmission defects
Image 2: SPECTRALIS® MultiColor Module - Multiple drusen
Image 3: SPECTRALIS® BluePeak Module - Punctate autofluorescence pattern consistent with SDD, inferior to macula, regions of both hypo and hyper autofluorescence indicating risks of RPE atrophy
Image 4: SPECTRALIS® simultaneous IR Reflectance and OCT - Multiple drusen and hyper-transmission defects
Image 5: SPECTRALIS® MultiColor Module - Multiple drusen and early RPE atrophy (iRORA)
Image 6: SPECTRALIS® BluePeak Module - Multiple autoflourescent drusen and regions of hypoautofluorescence indicating RPE atrophy
HEYEX 2 Multimodality Viewer (Image 7) brings all multimodal images together in the HEYEX 2 platform and offers side-by-side review with 3rd party images and AI reports from Heidelberg AppyWay AI Applications, in one single view.
Image 7: HEYEX 2 Multimodality Viewer with SPECTRALIS OCT, infrared reflectance image and 3rd party AI report from GA Monitor (RetInSight).
Patient Selection and Treatment Delivery
Professor Ursula Schmidt-Erfurth
“But how do we know which patients will benefit from therapy? If we only see loss of pigment, we know the lesion is not currently active. Studies indicate that this is around 25 percent of patients, so we review them every three months to catch the lesions when they become active.” PROF. URSULA SCHMIDT-ERFURTH, Chair of the Department of Ophthalmology and Optometry at the Medical University of Vienna
Read the full story on how Prof. Schmidt-Erfurth is pioneering use of AI for patient selection.
Treatment decisions for GA are centered around preserving macular vision. Identifying foveal sparing can be useful in assessing the potential for visual function and qualifying treatment success. A study from Apellis shows that the rate of lesion progression is higher in patients with foveal uninvolvement. Autofluorescence imaging makes clear visualization of lesion boundaries possible and can help the eyecare professional select the right patients who could show successful treatment outcomes, relative to the risks involved.
Using RegionFinder Software and change analysis on blue autofluorescence images allows quantification of macular atrophy and visualization of change over time. Learn to integrate RegionFinder in the clinical workflow (Video 2).
Leverage the Heidelberg AppWay to securely access third-party AI-driven ophthalmic clinical and research applications to assess disease activity, quantify atrophy, and consequently, select the right patients for treatment and provide timely interventions.
Monitoring and Follow-up
Christopher Mody
“Image-driven diagnosis and monitoring, hand-in-hand with new treatments, will bring benefits to an enormous group of patients. By providing two more years of driving, or, two more years of independent living for patients.“CHRISTOPHER MODY, Ophthalmic Photographer, Clinical Director, Heidelberg Engineering.
Read the full feature on how can GA patient care can be distributed with limited resources.
Evidence from clinical trials for GA therapy has indicated that it’s possible for a small cohort of patients to show signs of nAMD post GA therapy. A combined approach with OCT Angiography, multimodal imaging and AI insights from Heidelberg AppWay applications can help monitor inflammatory response and decide the future course of action.
Image 8: Geographic atrophy progression visualized in the Multimodality Viewer
Image courtesy: Prof. Frank Holz
Patient Education and Support
“Many of the therapies in the pipeline for geographic atrophy require significant commitment from patients and imagery is a strong part of that journey, with constant reinforcing messages. Some patients will say - ‘I am two to three years into my treatment and I am not seeing any changes – why am I still coming here?’” DR. CHRISTIANA DINAH, Consultant Ophthalmologist at London’s Middlesex Hospital, and Director of R&D at NW Healthcare NHS Foundation Trust.
Read the full story on how to engage AMD patients with their AMD care.
Patient compliance to treatment can be a huge challenge as results are slow to show and GA as a condition is not reversible. Listen and learn from Chris Lievens, OD, as he talks about the doctor-patient relationship in GA management in his latest podcast (Video 3). Further, visualizing changes in anatomy with images and progression videos can help patients understand which part of the eye is affected and what could happen next. Educating patients to watch out for symptoms and risk factors of AMD, and encouraging them to follow healthy habits – being mindful of their nutrition, reducing alcohol intake and ceasing smoking – can only help. SPECTRALIS helps to engagepatients in visualizing their condition with OCTA and BluePeak movie options (Video 4).
UNCOVER MORE on www.heidelbergengineering.com
Disclaimer: Not all features are available for sale in all countries.
