Dry age-related macular degeneration (AMD) may progress into geographic atrophy (GA), leading to vision loss in some people. Pegcetacoplan (Syfovre) is a newly approved medication that can help treat and slow progression.

AMD is a slow, progressive disease. For some people, AMD will develop into the advanced stage known as GA, which affects an estimated 1 million people in the United States. The disease can eventually lead to total vision loss.

There are two types of AMD: wet and dry, which is the most common. In dry AMD, damage to the macula’s light-sensitive cells causes visual disturbances, often starting as blurry vision that eventually leads to a loss of central vision. The macula sits near the center of the retina found in the back of the eye, which is why a person’s central vision is typically affected.

In 2023, the Food and Drug Administration (FDA) approved pegcetacoplan (Syfovre), the first medication to help treat GA. This may improve the outcome for people living with GA.

This article explores commonly asked questions on the outlook of GA.

GA is an advanced stage of dry AMD, which slowly progresses over time. Doctors and researchers often refer to the damaged area of the macula as a lesion. The progression rate refers to how quickly the lesion grows.

Researchers in a 2017 study noted that previous studies indicate a growth rate between 0.53 square millimeters (mm2) and 2.6 mm2 per year.

This growth rate may be conservative. According to the American Academy of Ophthalmology, the median lesion growth rate is 2.1 mm2 a year, with some reported rates as high as 10.2 mm2 per year.

Several factors affect how quickly the condition progresses. These include:

  • initial size of the lesion
  • number of lesions present
  • location of the lesion or lesions
  • high levels of hyper autofluorescence found on fundus autofluorescence (FAF) — a noninvasive imaging test of the eye
  • status of the other eye

Environmental, demographic, and genetic factors may also play a role.

GA progresses over time, causing permanent vision changes. Experts generally view the outlook as unfavorable due to the extensive loss of visual acuity. Older studies such as one from 1999 found that 31% of people lose up to three lines of visual acuity within 2 years from diagnosis.

Three lines refer to the early treatment diabetic retinopathy study (ETDRS) chart for vision testing. This chart breaks letters into 14 lines that decrease in size. Generally, the further a person can read the chart without error, the better their vision.

In other words, a person can lose a substantial amount of their central vision acuity following a diagnosis of GA.

Since GA does not affect the areas of the retina outside the macula, it does not usually affect peripheral vision. Total vision loss does not usually occur unless there are other serious eye issues or complications from treatment.

In 2023, the FDA approved pegcetacoplan as the first medication to treat GA.

In clinical trials, this injectable medication given monthly or every other month can help shrink GA lesions as well as slow their growth. The trials also showed that the effects may increase with ongoing treatments, helping a person further retain vision acuity with continued therapy.

Researchers also continue to investigate new medications in clinical trials.

Prior to the release of pegcetacoplan, treatment involved making healthy lifestyle changes where necessary. These may include:

  • stopping smoking
  • eating a healthy, balanced diet full of fruits and vegetables
  • participating in regular exercise
  • taking supplements or vitamins
  • wearing sunglasses

A person may also want to consider the use of visual aids. This can include:

  • using brighter lights
  • reading large print publications
  • using magnifying devices
  • using specialized computers, tablets, or programs that can help read applications

Even with treatment, a person should still consider making appropriate lifestyle changes and discuss their options with an eye doctor.

GA is a late stage of dry AMD.

An eye doctor may be able to identify the development by examining the eye. An early sign of GA is the development of drusen. Drusen are deposits on the retina made up of proteins, fats, and other debris that appear yellowish on a dilated eye exam.

A person may first notice changes in their ability to read or drive. They may experience waviness to straight lines as well as changes in contrast sensitivity. As the disease progresses, they may note a decrease in visual acuity.

Experts state that when GA affects the fovea, a central area of the retina where acuity is highest, it can lead to a rapid decline in their ability to see.

According to an older 2007 study, about 3.5% of people 75 years and above have GA, and about 22% of individuals over 90 years have the condition.

In a 2021 study, researchers noted that GA is an increasing issue in an aging population. In their study of 171 people, the mean age of onset was 82.6 years.

Other experts note that the typical age of onset is around 60 years and older.

GA is a progressive, late stage development of dry AMD. The condition causes irreparable loss of visual acuity.

For years, doctors suggested lifestyle changes, including stopping smoking, exercising regularly, and eating a healthy diet. In 2023, the FDA approved the first medication for GA that can help slow the progression and potentially shrink lesions.

Future treatments are currently under investigation and may be available in the coming years once approved.