Expert

What is Geographic Atrophy?

Scheie Eye Institute, University of Pennsylvania
Wednesday, April 5, 2017
An eye doctor examining a patient's eyes for geographic atrophy

Learn about the advanced form of dry age-related macular degeneration, called geographic atrophy.

Some patients with age-related macular degeneration (AMD) will develop geographic atrophy (GA), which refers to regions of the retina where cells waste away and die (atrophy). Sometimes these regions of atrophy look like a map to the doctor who is examining the retina, hence the term geographic atrophy. The regions of atrophy result in a blind spot in the visual field.

Symptoms

A photo showing geographic atrophy associated with intermediate macular degeneration.
National Eye Institute, National Institutes of Health
A photo showing geographic atrophy associated with intermediate macular degeneration.
The initial symptom may be found during reading, when one or several letters in a word are “missing.” Or, when looking at faces, a small part of the face cannot be seen. Usually, once  GA starts, the region of atrophy expands slowly over several years until the central vision is lost and vision is about 20/200. It does not normally affect peripheral vision.

Wet AMD and Geographic Atrophy

Patients with wet age-related macular degeneration, (wet AMD) will sometimes have GA before, during, or after they have the wet form of AMD; they are not mutually exclusive. GA can affect one or both eyes, and a patient with GA in one eye is more likely to develop it in the other.

Diagnosis

GA can be diagnosed by an ophthalmologist during a dilated exam and/or with retinal imaging. In a dilated exam, GA appears as a patch of retina that’s missing its dark melanin pigment. Imaging techniques including retinal color photographs, optical coherence tomography (OCT), or autofluorescence photographs can also be used to detect GA. Read more about the eye exam for macular degeneration.

Treatment

There is currently no proven treatment for GA. Patients can benefit from increased lighting, magnification and low vision devices that help with reading. Some patients may prefer an implantable miniature telescope, which is surgically inserted into the eye in place of the lens. It can help certain carefully selected patients with near or distance vision by magnifying images.

Clinical Trials

There are several ongoing clinical trials designed to slow or prevent expansion of GA, or to replace dead vision cells. Genentech/Roche has a phase III trial with lampalizumab, which is injected into the eye once a month. This drug inhibits an inflammatory pathway called the complement cascade, known to play a role in AMD. The results of the trial should be available this year.

The Geographic Atrophy Lipoic Acid (GALA) clinical trial is testing whether a once-per-day antioxidant/iron chelator pill can slow the growth of GA.

Additional clinical trials for GA can be found at antidote.me or clinicaltrials.gov.

Cell replacement is also being tested for GA. A few patients have received stem cell treatments . The most promising of these have the cells grown on plastic sheets, which are surgically placed under the retina and unrolled into position. The cells have been well-tolerated and can survive in the recipient’s eye for at least a year.

Summary

GA robs sight, but advances in low vision therapy (by specially trained optometrists) and implantable miniature telescopes can help patients adapt to their diminished retinal function. New treatments already in clinical trials or being tested in National Institutes of Health (NIH) and/or foundation-funded labs—like those supported by Macular Degeneration Research, a BrightFocus Foundation program— bring hope for improved vision on the horizon.

Resources:

The information provided here is a public service of the BrightFocus Foundation and should not in any way substitute for personalized advice of a qualified healthcare professional; it is not intended to constitute medical advice. Please consult your physician for personalized medical advice. BrightFocus Foundation does not endorse any medical product, therapy, or resources mentioned or listed in this article. All medications and supplements should only be taken under medical supervision. Also, although we make every effort to keep the medical information on our website updated, we cannot guarantee that the posted information reflects the most up-to-date research.

These articles do not imply an endorsement of BrightFocus by the author or their institution, nor do they imply an endorsement of the institution or author by BrightFocus.

Some of the content may be adapted from other sources, which will be clearly identified within the article.

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