Key takeaways

  • Geographic atrophy (GA) is a condition that typically progresses slowly, with lesions expanding by about 1 square millimeter per year, leading to blind spots due to retinal deterioration.
  • Treatment options for GA range from lifestyle changes like dietary adjustments and quitting smoking to medical interventions such as antioxidant supplements and FDA-approved medications.
  • While treatments, like complement protein inhibitors, can slow the progression of AMD and GA, they don’t offer a cure or restore lost vision. This highlights the importance of early intervention to minimize permanent vision loss.

Age-related macular degeneration (AMD) often begins with the formation of drusen, which are deposits that develop beneath the retina. Over time, drusen can increase in number and grow larger.

These deposits damage the retina, which can then begin to thin and deteriorate around them. This process may eventually lead to geographic atrophy (GA). Areas of the retina affected by GA don’t receive or process much light because many of the photoreceptor cells in these regions have died. As a result, people may experience blind spots in their vision.

GA typically progresses slowly. On average, GA lesions expand about 1 square millimeter per year, though the rate of progression can vary from person to person.

There are several treatment options available for geographic atrophy, depending on the stage of the disease.

Very early in the disease, dietary changes may be recommended. This can include increasing intake of green leafy vegetables, fruits, and foods rich in omega-3 fatty acids.

For more moderate disease, antioxidant supplements such as the AREDS or AREDS2 formulations may be introduced.

If the disease continues to worsen, FDA-approved medications delivered by injection into the eye may be considered. These include pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay).

Smoking is a known risk factor for all forms of macular degeneration, and quitting smoking is strongly recommended for people with GA.

Lifestyle changes, such as quitting smoking and making dietary changes, should be considered as soon as a person is diagnosed with AMD.

The presence of moderate-sized drusen is typically an indication to begin AREDS or AREDS2 formula supplements.

Once GA is established and progression has been documented, complement protein inhibitors may be considered as a treatment option.

Supplements, such as AREDS2, may help reduce the risk of progression from dry AMD (which causes gradual retinal damage) to wet AMD (a progressive, late form of AMD).

In people with established GA, treatment with complement protein inhibitors can slow the progression of AMD and GA specifically. However, these treatments don’t cure the condition or restore lost vision.

Without treatment for AMD, the risk of disease progression increases. This includes a higher risk of bleeding and conversion from dry AMD to wet AMD.

If complement protein inhibitors aren’t started in people for whom they are indicated, geographic atrophy may progress more quickly. As GA advances, additional photoreceptor cells are lost, which can lead to further and permanent vision loss.

Dr. Vicente Diaz is an ABMS board certified ophthalmologist and Vice Chairman of Clinical Affairs at Yale Medicine and Chief of Ophthalmology at Yale Health. He specializes in ocular inflammatory and infectious diseases. He is also the chief of ophthalmology at Bridgeport Hospital and director of ophthalmology for the Bridgeport Hospital Burn Unit, where he oversees the care of all patients with Stevens-Johnsons syndrome, a rare and potentially lethal disease.