What are the symptoms of geographic atrophy?

Geographic atrophy causes slowly progressive loss of central vision. Early symptoms can include difficulty reading in low light, needing more light than usual, blurring of central vision, and difficulty recognizing faces. As GA advances, a scotoma — a blind or blurry spot — develops in the central visual field that gradually enlarges over time. Peripheral (side) vision is typically preserved. GA does not usually cause pain.

Is there a treatment for geographic atrophy?

Yes — as of 2023 and 2024, the FDA has approved two new treatments for geographic atrophy: pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay). Both are complement inhibitors given as intravitreal injections every 1-2 months. They have been shown to slow the rate of GA growth, helping to preserve remaining vision longer. While neither treatment reverses existing damage, they represent the first disease-modifying therapies for GA. Dr. Peter Karth at Retina Care offers these treatments.

How is geographic atrophy different from wet AMD?

Geographic atrophy is an advanced form of dry AMD — it progresses slowly through gradual loss of retinal cells without abnormal blood vessel growth. Wet AMD involves the growth of abnormal blood vessels (neovascularization) beneath or into the retina that can leak fluid or blood, causing rapid vision loss. Wet AMD can develop alongside or as a conversion from GA. While wet AMD is treated with anti-VEGF injections, GA has its own new treatment options. Regular monitoring is essential for both conditions.

Geographic Atrophy: Causes, Symptoms, and Treatment

Q: What is geographic atrophy?

Geographic atrophy (GA) is the most advanced form of dry age-related macular degeneration (AMD). It occurs when the cells of the retinal pigment epithelium (RPE) — a layer of cells that support the light-sensitive photoreceptors — progressively die off, creating expanding areas of atrophy (tissue loss) in the macula. This leads to gradual, permanent loss of central vision. GA typically progresses slowly over years, and both eyes are often eventually affected.

Q: How is geographic atrophy diagnosed?

Geographic atrophy is diagnosed through a comprehensive dilated eye exam combined with advanced imaging. Optical coherence tomography (OCT) and fundus autofluorescence (FAF) imaging are the primary tools used to identify and measure the areas of atrophy. These tests are non-invasive and allow Dr. Peter Karth to accurately map the extent of GA, monitor progression, and guide treatment decisions.

What Is Geographic Atrophy?

Geographic atrophy (GA) is an advanced form of dry age-related macular degeneration (AMD) in which the light-sensitive cells of the macula — the central part of the retina responsible for sharp, detailed vision — slowly break down and die. The term “geographic” refers to the map-like pattern of cell loss visible on retinal imaging. Unlike wet AMD, geographic atrophy does not involve abnormal blood vessel growth or sudden fluid leakage. Instead, it progresses gradually, often over years, as areas of retinal pigment epithelium (RPE) and overlying photoreceptors degenerate and disappear.

Geographic atrophy affects millions of Americans and is one of the leading causes of permanent central vision loss in people over 60. Because it advances slowly and may affect one eye more than the other for a long time, many patients are unaware of the disease until significant damage has occurred. There is no cure, but treatments are now available that can meaningfully slow its progression.

Symptoms of Geographic Atrophy

Geographic atrophy typically causes gradual changes in central vision. Peripheral (side) vision is usually preserved. Common symptoms include:

Blurry or hazy central vision — difficulty reading, recognizing faces, or seeing fine detail
Scotoma (blind spot) — a dark, blurry, or missing area in the center of vision
Difficulty adapting to low light — trouble seeing in dim conditions or transitioning from bright to dark environments
Colors appearing washed out or less vivid
Straight lines appearing slightly distorted
Reading requiring brighter light or magnification than before

Symptoms often worsen slowly over months to years. Because central vision is affected while side vision remains intact, patients can still navigate independently but may lose the ability to drive, read, or recognize faces as the condition advances.

How Is Geographic Atrophy Diagnosed?

Diagnosing geographic atrophy requires a comprehensive retinal examination and specialized imaging. Dr. Peter Karth uses several advanced diagnostic tools:

Optical Coherence Tomography (OCT)

OCT produces high-resolution cross-sectional images of the retina, allowing Dr. Peter Karth to measure the thickness of retinal layers, identify areas where RPE cells have been lost, and monitor the progression of atrophic lesions over time. OCT is the cornerstone of geographic atrophy monitoring.

OCT Angiography (OCT-A)

OCT-A provides detailed mapping of blood flow in the retinal and choroidal layers without requiring dye injection. This helps distinguish geographic atrophy from wet AMD and detect any early conversion to the neovascular (wet) form, which can complicate the disease in some patients.

Fundus Autofluorescence (FAF)

FAF imaging uses naturally occurring fluorescence in retinal pigment epithelium cells to map areas of RPE health and damage. In geographic atrophy, areas of cell death appear as dark (“hypo-autofluorescent”) patches, while areas of stressed but still-living RPE appear bright. FAF is particularly useful for measuring the total area of atrophy and predicting where the lesion is likely to grow next.

Fluorescein Angiography

When there is concern about conversion to wet AMD or other vascular complications, fluorescein angiography provides a detailed view of retinal blood vessels and any abnormal leakage. This test involves an intravenous dye injection and sequential retinal photography.

Treatments for Geographic Atrophy

Until recently, geographic atrophy had no approved treatments. That changed in 2023 with the FDA approval of the first two drugs specifically indicated for GA. Both work by targeting the complement cascade — a part of the immune system that, when overactivated, contributes to the inflammation and cell death that drives geographic atrophy.

Syfovre (Pegcetacoplan)

Syfovre (pegcetacoplan), developed by Apellis Pharmaceuticals, was the first drug approved by the FDA for geographic atrophy, receiving approval in February 2023. It is a C3 complement inhibitor, meaning it blocks the complement pathway upstream, preventing the cascade of inflammatory reactions that destroy RPE and photoreceptor cells.

Syfovre is delivered as an intravitreal injection (directly into the vitreous cavity of the eye) and is typically given every 25 to 60 days depending on disease activity and patient response. In clinical trials (OAKS and DERBY), Syfovre reduced the rate of GA lesion growth by approximately 22% at 12 months with monthly dosing and 16% with every-other-month dosing compared to sham injection — a meaningful slowing of a disease that previously had no effective treatment.

Syfovre does carry a small risk of converting dry AMD to wet AMD (neovascular AMD), which is why close monitoring with regular OCT imaging is important during treatment.

Izervay (Avacincaptad Pegol)

Izervay (avacincaptad pegol), developed by Astellas Pharma, received FDA approval in August 2023 as the second treatment for geographic atrophy. It is a C5 complement inhibitor — it acts downstream in the complement cascade from Syfovre, blocking C5 cleavage to prevent the formation of the membrane attack complex that damages retinal cells.

Izervay is also administered as a monthly intravitreal injection. In the GATHER1 and GATHER2 clinical trials, it reduced GA lesion growth by approximately 35% at 12 months compared to sham injection. Like Syfovre, Izervay carries a small risk of converting to wet AMD and requires regular monitoring.

Choosing Between Syfovre and Izervay

Both Syfovre and Izervay slow geographic atrophy progression rather than reversing existing damage or restoring lost vision. The choice between them depends on individual patient factors including lesion size and location, fellow eye status, overall health, insurance coverage, and treatment schedule preferences. Dr. Peter Karth will review your imaging and discuss which option — or whether either option — is appropriate for your situation.

Managing Conversion to Wet AMD

A subset of patients with geographic atrophy will develop neovascular (wet) AMD — abnormal blood vessel growth beneath the retina — either as a natural progression of their disease or as a rare side effect of complement inhibitor therapy. If this occurs, treatment shifts to anti-VEGF injections (such as Vabysmo, Eylea HD, or Eylea) to suppress the abnormal vessels and prevent further vision loss. Regular monitoring makes early detection and treatment possible.

Nutritional Supplementation (AREDS2)

The AREDS2 formulation (vitamins C and E, lutein, zeaxanthin, zinc, and copper) was shown in large National Eye Institute clinical trials to reduce the risk of advanced AMD progression by about 25% in patients with intermediate AMD or advanced AMD in one eye. While AREDS2 supplements do not treat established geographic atrophy directly, they remain an important part of comprehensive AMD management for many patients and can help protect the fellow eye.

Low Vision Rehabilitation

For patients who have already experienced significant central vision loss from geographic atrophy, low vision rehabilitation can help maximize the use of remaining vision. This may include specialized magnifying glasses, electronic magnifiers, eccentric viewing training (learning to use peripheral vision more effectively), and adaptive technology. Dr. Peter Karth can provide referrals to low vision specialists when appropriate.

Geographic Atrophy vs. Wet AMD: What’s the Difference?

Age-related macular degeneration has two main forms. Dry AMD (which includes geographic atrophy in its advanced stage) progresses slowly through gradual accumulation of drusen deposits and RPE changes. Wet AMD (neovascular AMD) involves sudden growth of abnormal, leaky blood vessels beneath the retina that can cause rapid, severe vision loss over days to weeks. Geographic atrophy is the advanced stage of dry AMD and typically progresses much more slowly than wet AMD, though the cumulative vision loss can be just as significant over time. Some patients have both forms simultaneously or develop wet AMD on top of existing geographic atrophy.

Why Choose Retina Care for Geographic Atrophy Treatment?

Dr. Peter Karth is a board-certified vitreoretinal surgeon with specialized fellowship training in diseases of the retina. He brings subspecialty-level expertise in AMD — including geographic atrophy — to patients across southern Oregon and the northern California border region through clinics in Eugene, Springfield, Coos Bay, and the surrounding communities.

Patients with geographic atrophy benefit from the continuity of care that comes with seeing the same specialist at every visit. Dr. Peter Karth personally performs all intravitreal injections, interprets all imaging, and makes all treatment decisions. There are no mid-level providers substituting for the physician at Retina Care.

If you have been diagnosed with geographic atrophy, dry AMD, or advanced AMD, or if you have a family history of AMD and are concerned about your risk, we encourage you to schedule a consultation. Early detection and proactive monitoring are the most important steps in protecting your long-term vision.

Schedule an Appointment

To be evaluated for geographic atrophy or to discuss treatment options with Dr. Peter Karth, please call our office or use the contact form below. We see patients at multiple locations throughout the region to make specialist care as accessible as possible.

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