Best Treatments for Geographic Atrophy (GA): Latest Options and What to Expect
Explore the most effective, up-to-date treatments for geographic atrophy, including drug therapies, lifestyle adaptations, and what you need to know about managing this vision-threatening disease.
Understanding Geographic Atrophy (GA)
Geographic atrophy (GA) is a severe, advanced form of dry age-related macular degeneration (AMD) characterized by the progressive loss of tightly packed cells in the retina, particularly the retinal pigment epithelium (RPE). This damaging process predominantly affects central vision and is irreversible. GA is currently estimated to affect about 1 million people in the United States, predominantly those aged 65 and older. Individuals living with GA often face escalating difficulty with central vision tasks, impacting daily activities such as reading, driving, and recognizing faces.
What Causes Geographic Atrophy?
While the exact cause of GA is not fully established, researchers attribute it primarily to a cumulative interplay of genetic susceptibility, age-related changes, and environmental risk factors. There is growing evidence that overactivity of an immune response pathway, specifically the complement cascade, plays a central role in the destruction of retinal cells in GA. Key risk factors include:
- Advanced age
- Family history of AMD
- Smoking
- Poor cardiovascular health (e.g., high blood pressure, high cholesterol)
- Light iris color (eye color)
- Consistent exposure to UV light
GA is not contagious and cannot be transmitted from person to person.
Symptoms and Diagnosis of Geographic Atrophy
The progress of GA is typically slow and may go unnoticed in its early stages, especially if it affects only one eye initially. However, as the condition advances, individuals can experience significant vision loss. The most common symptoms include:
- Blurry or fuzzy central vision
- Areas of vision loss or blind spots in the central field
- Difficulty seeing in low light or at night
- Trouble with tasks requiring detailed sight, such as reading, recognizing faces, or driving
Diagnosis usually starts with a comprehensive eye exam, which may involve:
- Optical Coherence Tomography (OCT): Provides detailed cross-sectional images of the retina
- Fundus Autofluorescence (FAF): Highlights areas of atrophy in the retina
- Color Fundus Photography: Records the appearance of the retina for monitoring
Current Treatment Options for Geographic Atrophy
Until recently, therapeutic choices for GA were limited to lifestyle modification, nutritional supplements, vision rehabilitation, and supportive care. However, recent FDA approvals have ushered in a new era of medical treatments targeting disease progression.
What others are reading
1. FDA-Approved Intraocular Injections
In 2023, two major drugs were approved in the United States to treat GA. These medications aim to slow, but not stop or reverse, the progression of the disease.
| Drug Name | Brand | Mechanism | How It’s Given | Key Points |
|---|---|---|---|---|
| Pegcetacoplan | SYFOVRE™ | Inhibits complement C3 pathway | Monthly or every other month eye injection | First drug approved to slow GA lesion growth |
| Avacincaptad pegol | IZERVAY™ | Targets complement C5 protein | Monthly eye injection | Specifically slows rate of retinal cell death |
Both medications are delivered as injections directly into the eye (intraocular injections) by a retina specialist in a sterile setting, typically in an outpatient clinic. The dosing schedule can be monthly or bimonthly, depending on the patient’s disease progression and the specific medication used.
Effectiveness of Drug Therapies
- Both drugs slow down the progression of retinal cell loss in GA, but they do not reverse or restore lost vision.
- When started early, treatment can help patients preserve usable vision and maintain independence for longer.
- These drugs do not halt the progression completely. GA lesions may still enlarge, just at a slower rate compared to untreated disease.
Risks and Considerations
- Side effects of intraocular injections may include increased risk of infection ( endophthalmitis), increased ocular pressure, eye pain, or inflammation.
- There is a small but real increased risk of developing wet AMD (from 3% in untreated to as high as 12% with treatment).
- The injections require regular follow-up and monthly visits may be burdensome for some patients.
2. AREDS2 Nutritional Supplements
Although nutritional supplements have not been shown to stop GA or reverse vision loss, they remain a standard recommendation for patients with AMD, based on the Age-Related Eye Disease Study 2 (AREDS2) formulations. These supplements contain antioxidant vitamins and minerals, such as:
- Vitamin C
- Vitamin E
- Zinc
- Copper
- Lutein and zeaxanthin (carotenoids)
AREDS2 supplements may help reduce the risk of progression to advanced AMD in certain patients, though their impact on established GA lesions is thought to be limited.
3. Visual Rehabilitation and Supportive Care
Given the permanent central vision loss caused by GA, many patients benefit from vision rehabilitation strategies and assistive devices. Rehabilitation includes:
- Low-vision aids such as magnifiers, special glasses, and electronic reading devices
- Orientation and mobility training for safer navigation
- Occupational therapy to adapt home and work environments
- Support groups and counseling for emotional well-being
4. Ongoing Monitoring and Early Intervention
Regular follow-up with an eye care specialist is crucial to:
- Monitor for changes in vision or progression of GA
- Catch conversion to wet AMD early, which may benefit from other treatments
- Update treatment plans as new options become available
Limitations of Current Treatments
New drug therapies offer hope by slowing the progression of GA, but several limitations remain:
- No treatment currently restores lost vision or fully stops progression
- Monthly or bi-monthly intraocular injections are invasive and can be difficult for some patients to sustain
- Cost and insurance coverage may vary by region and provider
- Both SYFOVRE™ and IZERVAY™ have a small increased risk of developing wet AMD, which must be monitored
Future Directions and Research for Geographic Atrophy
Research into GA is advancing rapidly, with several avenues being investigated:
- Additional complement inhibitors in development that target various steps in the immune cascade
- Gene therapies aiming to deliver one-time changes to the retina to halt disease progression
- Stem cell approaches seeking to regenerate lost retinal tissues
- Neuroprotective agents and anti-inflammatory compounds designed to protect remaining vision
Several clinical trials are underway, with hopes that future treatments may one day restore sight or even prevent GA from developing in at-risk individuals.
Living with Geographic Atrophy: Tips and Support
Although current treatments cannot restore sight, there are important strategies individuals with GA can use to maximize quality of life:
- Work closely with a retina specialist to discuss treatment and monitoring plans
- Use prescribed low-vision aids and adaptive devices in daily life
- Increase lighting and use contrast to make reading and navigation easier
- Seek orientation and mobility training, especially as vision loss advances
- Join support groups or counseling services to manage the emotional effects of vision loss
- Maintain heart and eye health by abstaining from smoking, controlling blood pressure, and eating a diet rich in leafy greens and omega-3 fatty acids
Frequently Asked Questions (FAQs)
Q: What is geographic atrophy (GA)?
A: Geographic atrophy is an advanced form of dry age-related macular degeneration. It involves the progressive loss of retinal cells, leading to permanent central vision loss, usually in people over 65 years of age.
Q: Can the new drugs cure GA?
A: No, currently available drugs such as SYFOVRE™ and IZERVAY™ are designed to slow disease progression but cannot restore sight or reverse damage already done by GA.
Q: How are the treatments administered?
A: Both SYFOVRE™ and IZERVAY™ are given as injections into the eye (intraocular injections) at a retina specialist’s office, and are administered monthly or every other month depending on the medication and patient needs.
Q: Are there any risks to these treatments?
A: Risks include an increased chance of developing wet AMD, as well as rare side effects such as eye infection, increased eye pressure, or retinal detachment. Patients are closely monitored for these complications.
Q: What should I do if I notice changes in my vision?
A: Seek prompt evaluation from an eye care specialist, especially if you experience sudden changes, new blind spots, or distortion. Early intervention can help preserve remaining vision and allow for timely treatment.
Key Points to Remember
- GA is serious: It is a major cause of irreversible vision loss in older adults.
- New treatments slow—do not stop or reverse—the disease: Monthly intraocular injections (SYFOVRE™, IZERVAY™) can preserve sight for longer.
- Vision rehabilitation matters: Low-vision aids, training, and practical support can help maximize independence.
- Ongoing research gives hope: New therapies and potential cures are on the horizon, with multiple clinical trials underway.
- Early diagnosis is critical: Regular eye exams and immediate attention to new vision symptoms are vital for best outcomes.
Summary Table: Geographic Atrophy Treatments
| Treatment Option | Description | Purpose | Limitations |
|---|---|---|---|
| SYFOVRE™ (Pegcetacoplan) | Eye injection targeting complement C3 | Slows lesion growth | Does not restore lost vision or halt progression |
| IZERVAY™ (Avacincaptad pegol) | Eye injection targeting complement C5 | Slows rate of cell loss | Requires ongoing injections; risk of wet AMD |
| AREDS2 Supplements | Antioxidant vitamin/mineral mix | Reduces risk of progression in some cases | Limited effect on advanced GA |
| Vision Rehabilitation | Low-vision aids, training, adaptations | Helps maximize remaining vision | Does not slow disease progression |
References
- https://www.southeasternretina.com/blog/geographic-atrophy-symptoms-what-to-watch-for-in-late-stage-amd
- https://www.webmd.com/eye-health/macular-degeneration/features/future-treatment-geographic-atrophy
- https://www.youtube.com/watch?v=onmsJ5KWFUw
- https://www.izervay.com
- https://my.clevelandclinic.org/health/diseases/24890-geographic-atrophy
- https://www.fightingblindness.org/diseases/geographic-atrophy
- https://www.mdfoundation.com.au/news/new-treatment-for-geographic-atrophy/
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