What Is Geographic Atrophy? Causes, Symptoms, Diagnosis, and Treatment
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Geographic atrophy is a progressive and advanced form of age-related macular degeneration (AMD) , a chronic eye condition affecting one in eight people age 60 or older worldwide.e60dc2a1-f33c-4a05-9b50-8e3e8e59762974b40048-3510-4fb9-8fa4-0715e4a3965b As a form of macular degeneration, geographic atrophy specifically targets the macula, the central portion of the retina that’s responsible for sharp, central vision. Geographic atrophy does not cause total blindness — but it can greatly impair your central vision, causing blind spots in the center of your vision while leaving your peripheral vision intact.
Geographic Atrophy Basics Basics Affecting nearly 20 million Americans, age-related macular degeneration is the leading cause of irreversible vision loss in people over age 60, according to the American Macular Degeneration Foundation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e67f71e5-4221-496d-be9a-d62f9a6d7b4d The vast majority of cases are of the “dry” type , in which small yellow deposits called drusen develop under the macula, leading to thinning and drying of the macula. Wet AMD , on the other hand, involves the production of new, abnormal blood vessels under the macular that are very fragile and leak blood and fluid. Geographic atrophy is a late-stage form of dry AMD. It’s not exactly rare, affecting about one million people in the United States, according to research published in 2023.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b5f346e8-4584-499d-a699-3b9dae1b4db1 It accounts for about 20 percent of all legal blindness caused by AMD.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298986f3fe-d2ed-4d4a-af18-b88039e655eb Geographic atrophy is characterized by the progressive loss of cells in the macula, resulting in the formation of distinct patches of atrophy (cell death). The atrophic patches often resemble a map or geographic shapes, hence the name. The areas of atrophy, called lesions, usually develop initially away from the fovea, the central area of the macula that’s responsible for the highest-quality vision, according to the Macular Society. As geographic atrophy worsens, these areas expand or spread and start affecting the fovea, leading to further impairment of central vision.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f88efda6-9c19-436b-bc89-59f7035552e0
Signs and Symptoms Symptoms Individuals with geographic atrophy often experience a gradual decline in central vision, most often beginning with blind spots or dark areas in their central vision (scotomas). Other common symptoms include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762944645bf4-7303-451d-bb92-bff01df085db Patchy vision that’s distorted or fragmented, with irregular patches of clear and blurred vision Difficulty seeing in dim or low-light settings Difficulty reading, driving, sewing, recognizing faces, and other tasks relying on central vision Diminished contrast sensitivity, making it difficult to distinguish between shades of color or perceive fine details Reduced vibrancy of colors
Causes and Risk Factors Causes Geographic atrophy is the last stage of dry AMD, which is believed to arise from a combination of genetic, environmental, and lifestyle factors. Research suggests that geographic atrophy may result from chronic inflammation and immunological responses that damage photoreceptors, the pigmented layer of the retina, and other visual structures.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bb957d95-c0e2-4e45-bf2f-8e9d7fd4cd8a Risk factors for geographic atrophy include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629e2e9ded4-a9be-4ef6-ad1f-de22785641fa Advanced age (60 or older) Race (white) Family history of macular degeneration or other eye-affecting genetic conditions Smoking Chronic conditions including obesity, cardiovascular disease, diabetes, and high cholesterol Chronic inflammation Poor vision (20/200 or worse) Poor diet low in fruits and vegetables
How Is Geographic Atrophy Diagnosed? Diagnosis Diagnosing geographic atrophy usually begins with your provider asking you about your symptoms, medical history, and family history. They’ll then conduct a comprehensive eye examination and order various diagnostic tests, according to the American Academy of Ophthalmology.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ea09aa21-dcc6-48cd-a665-1ee1adba033f These may include: Visual acuity tests to evaluate your central vision by having you read an eye chart. Microperimetry, a technique to evaluate visual function by stimulating the macula with varying intensities of light. Fundus autofluorescence, the standard imaging technology to visualize retinal structures and detect geographic atrophy lesions. Fluorescein angiography, which involves injecting a dye into the bloodstream to highlight any abnormal blood vessel growth. Optical coherence tomography, a noninvasive imaging technique that identifies lesions by detecting the loss of retinal layers. Multifocal electroretinography, an exam that measures the electrical activity in the retina when it is exposed to light of varying intensities.
Treatment of Geographic Atrophy Treatment Currently, there is no cure for geographic atrophy. In 2023, however, the U.S. Food and Drug Administration approved the first medications to treat geographic atrophy and slow its progression: pegcetacoplan (Syfovre) and avacincaptad pegol intravitreal solution (Izervay) . Both of the drugs calm the immune response to prevent further damage of retinal cells.e60dc2a1-f33c-4a05-9b50-8e3e8e597629384fdae2-34c4-47f9-96bd-1b4055b55c09 Approved in February 2023, Syfovre is injected into the eyes every 25 to 60 days, depending on your individual response to the drug. Clinical trials showed that Syfovre, when administered on a monthly or bimonthly basis for 24 months, can reduce the rate of geographic atrophy lesion growth by up to 36 percent.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299d53bdf6-deb0-47ff-9a82-e16629bcfa93 Potential side effects of Syfovre include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629250a64a3-4cae-44aa-ac3b-b2ac682997d5 Eye infection or retinal detachment (separation of the layers of the retina) Eye inflammation, which may cause eye redness, light sensitivity, and eye pain Changes in vision, including blurred, distorted vision, flashing lights, and small specks floating in your vision Blood in the white of the eye Development of wet AMD Izervay was approved in August 2023. It works differently than Syfovre, but it is also given as an eye injection once a month. Clinical trials showed Izervay can reduce the rate of geographic atrophy lesions by 35 percent over 12 months. Izervay can produce similar side effects as Syfovre.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ffb6a113-b83d-4d2d-a964-d3d66cbc7561 Trials are under way for many other potential therapies for geographic atrophy, including:e60dc2a1-f33c-4a05-9b50-8e3e8e59762970b6f380-ac0e-43d4-8042-f01345115019 Intravitreal brimonidine, which reduced lesion area growth within three months in a phase 2 clinical triale60dc2a1-f33c-4a05-9b50-8e3e8e5976293dace37c-853d-4054-811a-b00fae82d033 Stem cell therapye60dc2a1-f33c-4a05-9b50-8e3e8e5976296f9c0ed1-4062-431a-a597-203a63067b93 Intravitreal lampalizumab Topical ocular tandospirone Intravitreal Avacincaptad pegol Oral ALK-001 Oral emixustat hydrochloride Oral doxycycline RELATED: The Latest Treatments for Geographic Atrophy: What You Need to Know
Patient Resources Resources Living with low vision usually requires learning new ways to carry out daily activities, from personal hygiene tasks, housekeeping, and cooking to carrying out work, school, parenting, or caregiving responsibilities. Your eye doctor can likely put you in touch with local resources that can help. For more help and guidance on accessing rehabilitation services, two organizations may be able to help. The Lighthouse Guild offers a variety of services to people with low vision, including in-person vision exams, technology training, and more in New York City, and telehealth consultations for those not in New York. Additionally, it has online support services for teens, young adults, adults, and parents of children with vision loss. Contact the Lighthouse Guild to see whether it can help with your needs. VisionAware , a part of the APHConnect Center , provides written information for people living with vision loss — as well as their families, caregivers, healthcare providers, and social service professionals — on eye diseases and disorders, along with tips for living with blindness or low vision. It produces webinars on topics related to blindness and low vision, and it maintains a directory of services , where individuals can find contact information for organizations and agencies that serve people who are blind or visually impaired in the United States and Canada.
Resources We Trust American Academy of Ophthalmology EyeWiki: Geographic Atrophy American Macular Degeneration Foundation: Geographic Atrophy BrightFocus Foundation: Macular Degeneration Research National Eye Institute: Age-Related Macular Degeneration (AMD) Ophthalmic Edge: Accessibility and Technology
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