Geographic atrophy (GA) is a progressive eye condition that causes the deterioration of the macula, the part of the retina responsible for sharp, central vision. GA is considered an advanced form of dry age-related macular degeneration (AMD) and typically affects older adults. It leads to a gradual and irreversible loss of vision, significantly impacting daily activities such as reading, driving, and recognizing faces.

GA does not cause total blindness, but it can severely impair central vision. It often develops in one eye first but can affect both over time. While there is no cure yet, ongoing research and recent FDA-approved treatments aim to slow its progression and help patients adapt to vision changes.

Types of AMD

There are two primary types of age-related macular degeneration (AMD) that can lead to geographic atrophy: dry AMD and wet AMD.

Dry AMD

Dry AMD is the most common type and develops when the macula gradually thins due to aging. Protein deposits called drusen accumulate under the retina, disrupting the function of retinal cells. Dry AMD progresses through three stages: early, intermediate, and late. Geographic atrophy is considered the late stage of dry AMD.

Wet AMD

Wet AMD is a less common but more aggressive form of the disease. It occurs when abnormal blood vessels grow under the retina and leak fluid or blood. Although geographic atrophy is typically associated with dry AMD, people with wet AMD can also develop areas of atrophy over time.

Common Symptoms

Geographic atrophy progresses slowly and may not show symptoms in the early stages. As it advances, it causes a variety of visual disturbances:

  • Blurred or fuzzy central vision
  • Dim or dark spots in the center of vision
  • Increased need for bright light when reading or doing close work
  • Faded or dull colors
  • Trouble seeing in low-light conditions
  • Missing letters or numbers while reading
  • Visual hallucinations (Charles Bonnet syndrome) in advanced cases

Peripheral vision usually remains unaffected, so individuals may retain some functional sight even in late stages.

Causes and Risk Factors

Geographic atrophy is primarily linked to age-related changes in the eye. However, several factors contribute to its development:

Age and Genetics

  • Risk increases significantly after age 60
  • Family history of AMD or GA raises your risk

Lifestyle and Environmental Factors

  • Smoking is a major risk factor
  • Excessive sunlight exposure without UV protection
  • Poor diet lacking antioxidants and essential nutrients

Health Conditions

  • Diabetes
  • High blood pressure (hypertension)
  • Heart disease
  • High cholesterol
  • Obesity

Diagnosis

Diagnosing GA involves a comprehensive eye exam and advanced imaging techniques. Early detection is critical for managing progression.

Visual Acuity Test

  • Measures clarity of central vision using an eye chart

Dilated Eye Exam

  • Eye drops enlarge pupils so the retina can be examined for damage

Amsler Grid Test

  • Helps detect distortions or missing areas in central vision

Fundus Photography

  • Captures images of the retina for detailed analysis

Optical Coherence Tomography (OCT)

  • Provides cross-sectional images of the retina to detect thinning or damage

Fluorescein Angiography

  • Uses a dye to highlight blood vessels in the retina, useful for diagnosing wet AMD

Treatment Options

There is no cure for GA, but several treatments can slow its progression and help manage symptoms.

FDA-Approved Medications

Izervay (avacincaptad pegol)

  • Approved in 2023
  • Reduces lesion growth by up to 35%
  • Monthly intravitreal injections

Syfovre (pegcetacoplan)

  • Approved earlier in 2023
  • Slows GA progression with injections every 25 to 60 days

Anti-VEGF Therapy

  • Effective for patients who also have wet AMD
  • Injections reduce abnormal blood vessel growth

Photodynamic Therapy

  • Combines a light-sensitive drug and laser to target abnormal vessels

Nutritional Supplements

  • High-dose vitamins and minerals based on AREDS2 formula:
    • Vitamin C (500 mg)
    • Vitamin E (400 IU)
    • Zinc (80 mg)
    • Copper (2 mg)
    • Lutein (10 mg)
    • Zeaxanthin (2 mg)

Vision Aids and Rehabilitation

  • Magnifiers
  • Bright task lighting
  • Large-print reading materials
  • Voice-to-text software and assistive apps

Prevention Strategies

While GA cannot be entirely prevented, certain actions can reduce risk and slow progression:

  • Stop smoking
  • Eat a balanced diet rich in leafy greens, fish, and fruits
  • Wear sunglasses with UV protection
  • Control blood pressure and cholesterol
  • Exercise regularly
  • Take AREDS2 supplements if advised by an eye care provider

Related Conditions

Geographic atrophy is often associated with other vision and systemic health issues:

Blindness

  • GA is a leading cause of central vision loss in older adults

Depression

  • Up to 39% of people with AMD report clinical depression

Anxiety

  • Anxiety disorders are more prevalent in those with vision impairment

Other Eye Conditions

  • Glaucoma
  • Diabetic retinopathy
  • Cataracts

Living With Geographic Atrophy

Adjusting to life with GA involves a combination of medical care, lifestyle changes, and assistive tools. Tips for managing daily life include:

  • Routine eye exams every 6 months
  • Work with a low-vision specialist for personalized support
  • Use magnification tools for reading
  • Improve home lighting for safer navigation
  • Use digital tools like audiobooks, voice commands, and large fonts
  • Join support groups for emotional well-being and practical advice

Adapting to vision loss can be challenging, but many people maintain a good quality of life with proper support.

Final Thoughts

Geographic atrophy is a serious eye disorder that affects millions of older adults. While there is no cure, recent advancements in treatment and increased awareness offer hope for slowing its progression. Early detection, a healthy lifestyle, and regular eye care are key to preserving vision for as long as possible.

If you or a loved one experience changes in vision, consult an eye care professional promptly. The sooner geographic atrophy is detected, the better your chances of managing its effects.