How do you approach patient selection for starting intravitreal complement inhibitors?

Because complement inhibition seems to have only a modest effect on GA progression, no clear functional benefit in pivotal trials, and a not-insignificant risk of CNV and optic neuropathy, I tend toward a conservative view when deciding whether to recommend it to patients.

A good candidate, in my view, has a few characteristics:

• Good visual acuity in the eye I intend to treat. In other words, there should be a level of vision worth preserving. In my state, driving requires 20/40 vision in one eye, so an ideal candidate would have 20/40 or better vision in the treatment eye.
• Along the same lines, an ideal patient should have a reasonably good level of daily functioning and some independence worth preserving. The cost/benefit ratio of routi...