Syfovre and Izervay: The First FDA-Approved Treatments for Geographic Atrophy

Geographic atrophy, a part of Dry Macular Degeneration (Dry AMD) now has treatments: Syfovre and Izervay are the first FDA-approved treatments to slow geographic atrophy, the advanced form of dry AMD. Here’s what Oregon patients need to know.

For decades, geographic atrophy, which is the slow death of the cells responsible for your central vision, had no treatment. Patients with this advanced stage of dry age-related macular degeneration received monitoring and supplements but faced the steady loss of central vision with nothing to slow it down. That changed in 2023, when the FDA approved two new medications — Syfovre and Izervay — that target the root biological cause of geographic atrophy for the first time.

What Is Geographic Atrophy?

Geographic atrophy (GA) is the advanced stage of dry AMD. In early and intermediate dry AMD, tiny protein deposits called drusen accumulate beneath the retina, and the retinal pigment epithelium (RPE) — a support layer critical to photoreceptor survival — begins to deteriorate. In geographic atrophy, the RPE cells die off entirely in defined patches, taking the photoreceptors above them with them. These patches of dead retina, called atrophic lesions, expand slowly over months and years like a brush fire, erasing central vision in their path.

The macula, the small central region responsible for reading, driving, and recognizing faces, is the most common target. As atrophy creeps toward the fovea — the very center of the macula — patients notice increasing difficulty with tasks that require sharp central vision. Unlike wet AMD, geographic atrophy develops gradually, and many patients don’t notice significant symptoms until atrophy reaches the foveal center.

Why Geographic Atrophy Was So Difficult to Treat

Wet AMD is driven by abnormal blood vessel growth triggered by VEGF — a target that anti-VEGF injections address directly. Geographic atrophy operates differently. The cell death in GA is driven largely by the complement system, a branch of the immune system that, when overactivated, attacks and destroys the RPE cells that photoreceptors depend on. Without a clear molecular target, researchers struggled for years to find a drug that could interrupt this process.

The challenge was compounded by the slow pace of GA progression. Clinical trials needed to track patients for two years or more to measure treatment effects, and the primary endpoint — slowing the growth rate of atrophic lesions on imaging — required new measurement standards. The FDA approval of both Syfovre and Izervay represented a major shift, validating lesion growth rate as a meaningful endpoint and opening the door to treating a disease that had been considered untreatable.

How Syfovre and Izervay Work

Both drugs are called complement inhibitors — they block overactive complement signaling that damages RPE cells. They target different points in the complement cascade, but the goal is the same: reduce the inflammatory destruction driving geographic atrophy.

Syfovre (pegcetacoplan)

Syfovre was approved by the FDA in February 2023 as the first treatment for geographic atrophy. It targets complement C3, a central hub in the complement cascade, blocking activation both upstream and downstream. Syfovre is administered as an intravitreal injection — the same type of in-office eye treatment used for anti-VEGF therapy — given monthly or every other month. The OAKS and DERBY trials showed Syfovre reduced GA lesion growth rate by approximately 22 percent at two years with monthly dosing and around 16 percent with every-other-month dosing.

Izervay (avacincaptad pegol)

Izervay was approved in August 2023, six months after Syfovre. It targets complement C5, further downstream in the cascade, blocking the formation of the membrane attack complex — the final step that kills RPE cells. Izervay is given monthly by intravitreal injection. The GATHER1 and GATHER2 trials demonstrated approximately 14 to 35 percent slowing of GA lesion growth compared to sham at two years, with particularly strong results in patients with extrafoveal lesions.

What the Clinical Trials Really Showed

Both Syfovre and Izervay slow the growth rate of geographic atrophy lesions — they do not stop it, and they do not restore vision already lost. In the trials, patients on active treatment saw roughly 20 to 25 percent less lesion growth over two years compared to patients receiving sham injections. That translates to meaningful preservation of retinal tissue over time. This compounds over time. This translates into more time with better vision.

Importantly, visual acuity outcomes were more variable and less dramatic than lesion growth data. The drugs preserve retina, but the central vision benefit that patients experience depends heavily on lesion location, baseline vision, and how much functional retina remains. Patients with extrafoveal lesions — those that haven’t yet reached the center — tend to see the clearest benefit because the fovea is still intact and worth protecting.

There is also a recognized risk with both drugs: conversion to wet AMD. A subset of patients in the trials developed wet AMD (choroidal neovascularization) during treatment. Your retina specialist will monitor for this at every visit with OCT imaging and treat any wet AMD that develops with standard anti-VEGF injections.

Who Is a Candidate for Treatment?

Both drugs are approved for adults with geographic atrophy secondary to AMD. The decision to treat involves several factors. Your retina specialist will assess GA lesion size and location on fundus autofluorescence or OCT imaging, lesion growth rate (faster-growing GA benefits more from slowing), proximity to the foveal center, your remaining functional vision, and your overall health and treatment preferences.

Patients with end-stage GA centered on the fovea and severely reduced central vision may have less to gain from treatment, since the most critical retinal tissue is already lost. The best candidates retain functional central vision with growing extrafoveal or parafoveal lesions. Many patients throughout the Willamette Valley and the Oregon coast are in exactly this situation — diagnosed with GA and watching it progress at monitoring visits — and are now candidates for treatment that didn’t exist two years ago.

What Treatment Looks Like in Practice

Both Syfovre and Izervay are given by intravitreal injection in an outpatient clinic setting. The procedure takes only a few minutes. The eye is numbed with anesthetic drops, and a stronger anesthetic treatment, cleaned with antiseptic, and the medication is injected through the pars plana — a thin region of the eye wall — using a fine needle. With Dr. Peter Karth’s injection method, which patients strongly prefer over other methods, there is no sensation at the time of injection and no discomfort afterward, in nearly all cases.

For many patients in Eugene, Roseburg, Salem, and surrounding communities, maintaining regular injection schedules is a practical consideration. Retina Care has locations designed to minimize travel burden, and our team coordinates imaging and injection visits to make treatment as efficient as possible.

Insurance Coverage and Cost

Medicare Part B covers both Syfovre and Izervay as physician-administered drugs for geographic atrophy. Coverage typically requires documented GA on retinal imaging. Commercial insurance coverage varies by plan and may require prior authorization.

The team at Retina Care has extensive experience navigating insurance authorization for these newer medications. We work directly with Medicare and commercial insurers to secure coverage and connect patients with manufacturer assistance programs when out-of-pocket costs are a barrier. Our goal is that no patient in western Oregon declines treatment they need because of cost.

Setting Realistic Expectations

Syfovre and Izervay represent a real advance — the first proof that geographic atrophy can be pharmacologically slowed. But honest expectations matter. These drugs preserve what remains; they do not restore what is gone. A 20 to 25 percent reduction in lesion growth rate is meaningful over years, but it means the disease still progresses, just more slowly. Many patients won’t notice a dramatic change in how they see — the benefit is cumulative and shows in preserved retinal tissue on imaging over time.

For patients facing a diagnosis of geographic atrophy, that kind of preservation is worth pursuing. Starting treatment while meaningful foveal function remains is the goal — waiting until central vision is gone means the opportunity to protect it has passed.

At Retina Care, retinal specialist Peter Karth, MD, MBA, FASRS, FACS is happy to help you with your retina concerns. Please call 541-873-8462 to schedule an appointment at a location near you.

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