Dry Age-Related Macular Degeneration with Geographic Atrophy
Geographic atrophy (GA) is an advanced form of dry age-related macular degeneration (AMD). It is characterized by thinning of the macula, leading to permanent and progressive central vision loss. In the early stages of dry AMD, yellow deposits called drusen accumulate under the retina. As dry AMD worsens, geographic atrophy can sometimes develop. A patient may start off with several small, distinct areas of GA that gradually coalesce into larger areas of atrophy with time. Alternatively, dry AMD can sometimes progress to wet AMD, where abnormal blood vessels grow under the retina and cause further damage.
Diagnosis of Geographic Atrophy
GA is diagnosed by patient history and a careful retinal examination. An ophthalmologist may see drusen, pigmentary changes, and retinal thinning in the macula. The areas of atrophy typically have sharply demarcated borders. Diagnostic tests that are helpful in the diagnosis of GA include color fundus photos, ocular coherence tomography (OCT), fluorescein angiography, and fundus autofluorescence.
Treatment of Geographic Atrophy
There are limited options to reverse or halt the progression of geographic atrophy. Current smokers are encouraged to quit tobacco products. When dry AMD is in its early stages, it is recommended that patients take Age-Related Eye Disease Study (AREDS) 2 vitamins to slow the progression of the disease. Once geographic atrophy develops, however, these vitamins are no longer effective.
Other possible treatments for geographic atrophy are medications that block the activity of the complement system, which is a part of the immune system that can damage healthy cells, including those in the retina. There are currently two medications that are FDA approved for this purpose: Syfovre (pegcetacoplan) and Izervay (avacincaptad pegol). These medications are given as intravitreal injections and slow the progression of the disease. It is important to note that these medications do not reverse the atrophy that has already developed. There are other possible risks of these medications as well. Your retina specialist can help to determine if Syfovre or Izervay are suitable treatment options for you.
The Retina Consultants of Minnesota has an active clinical trials department consisting of a team of experienced physicians and support staff. Our department collaborates with researchers from around the country, including those at academic centers, other retina practices, and pharmaceutical companies. We have been involved in numerous clinical trials for geographic atrophy, looking for new treatments for this condition. We would be happy to discuss opportunities to participate in clinical research if you are interested.
These autofluorescence images show worsening of geographic atrophy in the macula of a patient’s right eye over several years. The area of atrophy is depicted as the enlarging black area in the center of each image.