Geographic Atrophy

Some patients with age-related macular degeneration (AMD) will develop geographic atrophy, an advanced and severe form of dry AMD that can lead to permanent vision loss.

What is geographic atrophy?

Geographic atrophy is an advanced and severe form of dry age-related macular degeneration. In geographic atrophy, regions of cells in the retina 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. Geographic atrophy can affect one or both eyes, and a patient with the disease in one eye is more likely to develop it in the other.

Geographic atrophy causes around 20% of legal blindness in North America. An estimated five million people worldwide have geographic atrophy, with roughly one million of them living in the United States.

Symptoms of geographic atrophy

In early dry macular degeneration, cells in the macula begin to waste away and die (atrophy), and parts of central vision become blurry. This may be difficult to notice at first, especially if the other eye is healthy, which can often hide the problems of the affected eye. Some people may find that they need more light to read but otherwise may not notice problems with their vision.

As dry macular degeneration slowly progresses, the blurring worsens and increases in size. Some permanent blind spots (called scotomas) in the visual field may develop. The person may begin to have trouble telling the difference between similar colors, or shades of the same color.

Symptoms of geographic atrophy include:

• Difficulty reading in dim lighting

• Poor night vision

• Central vision loss, including difficulty seeing faces, cooking, driving, etc.

• Black spot in central vision

• Slower reading speed; one or several letters in a word appear “missing”

• Difficulty distinguishing between different shades of similar colors or shades of the same color

• Trouble with glare

Risk factors for geographic atrophy

Certain risk factors increase a person’s chances of developing dry macular degeneration and geographic atrophy, including:

• Being older than 60

• Having a family history of macular degeneration

• Smoking or having smoked in the past

• Being obese

• Having light-colored eyes

• Spending a lot of time in the sun

• Caucasians are more likely to develop it than African Americans or Hispanics

• Eating a high-fat diet and/or low in nutrients and antioxidants

• Inactivity

Diagnosing geographic atrophy

If you have already been diagnosed with dry macular degeneration, ask your doctor how often you need to be monitored for potential progression to geographic atrophy.

A dilated eye exam is the first step to diagnosing geographic atrophy. The following imaging techniques can also be used in diagnosing or monitoring geographic atrophy:

• Fundus autofluorescence, which takes pictures (or fundus photos) of the retina, allows the retina specialist to see areas of the retina that are thinning as well as the underlying layer, known as retinal pigment epithelium (RPE).

• Optical Coherence Tomography (OCT), which shows a cross-section view of the retina to measure the different layers and their thicknesses. This technique can identify regions of the retina that are thinning, indicating the presence of geographic atrophy.

Learn more about the diagnostic tools your doctor may use to diagnose geographic atrophy.

Treatments for geographic atrophy

The first treatments for geographic atrophy were approved by the U.S. Food and Drug Administration in 2023. The first, Syfovre, was approved in February 2023, followed by Izervay in September 2023. Both treatments slow the progression of the disease by targeting inflammation in the complement pathway system in the eye.

BrightFocus is funding innovative research into new drugs and ways to manage and treat this complex form of AMD.

Living well with geographic atrophy

Despite its severity, macular degeneration usually doesn’t affect both eyes equally. Many people find they can adapt and function by making the most of their remaining vision; some find new ways to accomplish their daily activities through vision rehabilitation. Certified low-vision therapists can help you make the most of your remaining vision with special vision aids and devices such as magnifiers, and occupational therapists can help you do everyday tasks and chores, such as setting up your kitchen, bathroom, lighting, etc., in new ways. These two types of low-vision evaluations are typically reimbursable by private insurers and Medicare.

Your initial visits to these specialists are not just a one-time experience. These doctors will help you adapt as your vision continues to change. With this type of professional assistance, you can learn to develop new ways of doing the things you love as your vision changes and maintain your independence and quality of life.

To preserve remaining vision, it’s important to protect your eye health. Here are a few steps to take:

• If you are a smoker, stop right away.

• Eat a healthy diet rich with antioxidants and omega-3 such as fish, whole grains, and dark leafy greens.

• Exercise regularly.

• Ask your eye doctor if the AREDS2 formula of vitamins and minerals would be beneficial.

• Get regular, dilated eye exams as recommended by your doctor, and use an Amsler grid to monitor your vision.

• Request a referral for a low vision therapist or occupational therapist in your area. Listen to a conversation with a low vision specialist about how these professionals can help.

Geographic atrophy and mental health

People living with geographic atrophy often experience emotional hardships including anxiety, feeling powerless, and frustration. Approximately one in three have recently withdrawn from their social lives because of their disease. Learn more about coping with vision loss.

Looking for ways to connect with others? Join our Community Circle, a monthly, 45-minute program designed to help people with macular degeneration share tips, ask questions, and build community. Meetings are private, held on Zoom, and not recorded. If you are unable to join via Zoom, there is also an option to call in by phone. The meetings are scheduled for the third Friday of each month at 2:00 pm Eastern. Email Amanda Russell at arussell@brightfocus.org to learn more.