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Living Well with Geographic Atrophy

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From Dry AMD to Geographic Atrophy: Understanding Disease Progression

Medically Reviewed By Grace Zhang, MD

Sometimes, dry age-related macular degeneration (AMD) can progress to an advanced stage known as geographic atrophy (GA). However, the progression rate and loss of central vision can vary from person to person.

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Geographic atrophy (GA) is a leading cause of central vision loss. GA is the advanced stage of the dry form of age-related macular degeneration (AMD). It develops when cells begin to die in the retina, which is the light-sensitive area at the back of the eye. As a result, lesions form and cause blind spots in your central field of vision. 

However, the growth rate of this condition varies from person to person, and the time it takes to notice vision loss can also vary. Here’s what you can expect if you’re one of the approximately 20% of people with dry AMD who develop geographic atrophy.

Progression can vary

Because geographic atrophy is a progressive disease, its symptoms can become severe as time passes. That is, you may lose more vision as time goes by as your disease advances. 

Typically, the lesions develop in the outer retina. Then, over time, the atrophy expands to eventually cover the macula, which is the central part of the retina, and the fovea, which is located near the center of the macula and is responsible for your sharp central vision.

However, the progression, or rate of growth of those lesions, can vary. 

A 2021 study Trusted Source JAMA Peer reviewed journal Go to source suggests the average enlargement rate of the lesions is 1.09 square millimeters (sq mm) per year, but the specific enlargements range from 0.02 to 4.05 sq mm per year. 

Certain factors Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source also seem to play a role in influencing the development and progression of GA, such as: 

  • size of the lesion at the time when you first receive the diagnosis
  • location of the lesion
  • number of lesions
  • both eyes affected

Your doctor may also pay close attention to the levels of autofluorescence Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source in the inside back surface of your eye, the area known as the fundus. If you have areas of atrophy inside your eye, imaging studies can show high levels (or hyperautofluorescence) in those areas. That can indicate disease progression. 

Essentially, if you have more lesions or bigger lesions, that’s usually a sign that the disease is progressing more quickly. And once the lesions have involved the fovea, you may begin to notice much more central vision loss. 

New treatments can slow progression

In 2023, the Food and Drug Administration (FDA) approved two treatments for geographic atrophy: Syfovre pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay). In clinical trials, these medications, which are injected into the eye, slowed down the development of GA by 14% to 20%

By slowing the growth of the lesions, these medications can preserve more of your vision. However, the benefits are limited. These medications cannot restore your lost vision, and they can have some side effects. You also have to be willing to get injections in your eye on a monthly or bimonthly basis. 

Research is ongoing and additional treatments are in the pipeline.

A 2023 study Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source suggests that a health-promoting lifestyle can also help slow down the progression of geographic atrophy. This includes eating a nutritious and balanced diet that’s high in vegetables, fruits, and whole grains and monitoring consumption of high fat dairy and red meat. Since smoking is a risk factor for GA, quitting — if you smoke — may also help slow disease progression. 

Takeaway

The good news is that you do not have to figure this all out on your own. Your doctor is your partner on this journey.

Make sure to keep all your regular appointments with your doctor and let them know about any changes to your vision or concerns you may have.

Your doctor can help you understand more about GA disease progression and the appropriate treatment and other supportive options, including low vision aids and coping strategies. 

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  1. Abdin AD, et al. (2023). Prevalence of geographic atrophy in advanced age-related macular degeneration (AMD) in daily practice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10381805/#
  2. Antonio-Aguirre B, et al. (2023). Treating patients with geographic atrophy: Are we there yet? https://journalretinavitreous.biomedcentral.com/articles/10.1186/s40942-023-00493-6
  3. Bakri SJ, et al. (2023). Geographic atrophy: Mechanism of disease, pathophysiology, and role of the complement system. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10408405/
  4. Colijn JM, et al. (2021). Enlargement of geographic atrophy from first diagnosis to end of life. https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2780306
  5. Keskek NS, et al. (2021). The use of fundus autofluorescence in dry age-related macular degeneration. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251671/
  6. Mukamal R. (2024). What to know about Syfovre and Izervay for geographic atrophy. https://www.aao.org/eye-health/tips-prevention/syfovre-izervay-geographic-atrophy-amd-macular-deg
  7. Regillo CD, et al. (2024). Considerations for the identification and management of geographic atrophy: Recommendations from an expert panel. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10850989/
  8. What is geographic atrophy? (n.d.). https://macularhope.org/geographic-atrophy/

Medical Reviewer: Grace Zhang, MD
Last Review Date: 2024 Apr 1
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