How do you determine when to discontinue anti-complement therapy in patients with geographic atrophy who already have center-involving disease given the minimal likelihood of central vision improvement but the potential for more rapid scotoma expansion if treatment is withdrawn?

Since these drugs have a significant risk and a marginal benefit, not to mention the significant treatment burden and their outrageous cost, it begs the question of how often they should be used altogether.

I will determine the rate of progression prior to starting therapy, and I will monitor for a change in this slope/rate after treatment. If I do not see a change in slope, I will discuss with the patient. In such a situation where the benefit is not apparent, patients will usually choose discontinuat...