The Progression of Geographic Atrophy

More than 5 million people worldwide have geographic atrophy (GA). This advanced stage of dry age-related macular degeneration causes lesions to grow on the parts of your retina that receive light and focus your central vision.

GA progresses over years based on a number of factors related to your overall health and wellness. Although there isn’t a cure, there are steps you can take that may help slow its progression.

Ophthalmologist and retina specialist Ananth Sastry, MD, explains what it takes to slow progression and what to expect if you’ve been diagnosed with this condition.

How geographic atrophy progresses

Most of the time, GA progresses slowly over several years, with lesions growing at an average rate of 1.66 to 1.78 millimeters each year. These lesions are caused by drusen — yellow protein deposits that form beneath your retina.

As these deposits grow, the photoreceptors of your eye become thin. This makes it hard to catch and convert light into something you can see. As a result, the photoreceptors start to die off. In their absence, lesions begin to grow toward the fovea — the part of your retina that provides sharp, detailed vision.

“Early on, you might notice changes like letters or words disappearing while you read, or you’ll notice a blind spot that slowly increases in size,” says Dr. Sastry. “As GA progresses, more and more of your central field will become blurry.”

If progress isn’t slowed, lesions can grow over the fovea. When this happens, you experience irreversible central vision loss that can complicate everyday tasks like reading, driving or recognizing faces.

“You’ll still be able to see in the periphery, but the center will become very blurred,” explains Dr. Sastry. “At that stage, we work to improve your quality of life, help you learn how to live with low vision and find ways to maintain the vision you still have.”

Factors that influence progression

“Not everyone who has age-related macular degeneration will develop geographic atrophy,” notes Dr. Sastry. “About 20% to 30% of people who have it will develop GA.”

How fast GA develops depends on different factors, such as:

• Genetics: Some people inherit genes that can make GA worse.
• Age: The older you are, the faster GA can progress.
• Size: More retinal cells are at risk of dying the larger lesions grow.
• Location: Lesions that grow closer to the fovea lead to more noticeable vision loss.
• Overall health and wellness: Inflammation and smoking accelerate GA progression and increase your risk of damage. “Smoking is a major risk factor for the development of macular degeneration and the progression of GA,” says Dr. Sastry.

Tips for monitoring and managing geographic atrophy

Scientists continue to look for ways to recover vision and revive areas that’ve been damaged by GA. A recent study in The New England Journal of Medicine found some success in restoring central vision with the help of a retinal implant. But this study was very small, and more clinical trials are needed before these treatments become widely available.

“Apart from that, we don’t have anything else that can actually recover vision,” says Dr. Sastry.

Still, there are things you can do to help slow the progression of GA and maintain the vision you have. Dr. Sastry recommends the following:

• Ask your doctor if AREDS supplements are right for you. These over-the-counter supplements have been shown to slow and minimize the risk of GA by combining vitamins C and E, lutein, zinc, copper and zeaxanthin.
• Consider U.S. Food and Drug Administration (FDA)-approved injections. Izervay™ and Syfovre® can slow the progress of GA. These medications are injected directly into your eye every one to two months. They work by calming your immune response and preventing retinal damage.
• Reduce known risks. Quit smoking and focus on improving healthy habits related to nutrition, exercise and safety.
• Monitor progression with regular follow-ups. “A retina specialist will be able to take multiple images to measure the rate of progress and growth,” says Dr. Sastry. “Along the way, we can recommend different treatments and find what works.”
• Connect with a low-vision specialist. If your vision loss starts to affect your ability to drive or carry out other tasks, they’ll be able to recommend assistive devices and other techniques to help improve your quality of life.

“If we’re not able to get your vision better than 20/60, a low-vision specialist can help you learn how to live with GA,” shares Dr. Sastry. “Treating GA has challenges, but our goal is to make sure you live as full a life as possible. We do that by slowing the progression of GA and maintaining the vision you still have.”