9 Tips for Living Well With Geographic Atrophy

Being diagnosed with geographic atrophy (GA), the final stage of dry age-related macular degeneration (AMD), can be a big blow. Once your vision has deteriorated to that point, the retina damage is permanent and may continue to progress. It’s natural to be upset, worried and even angry about having a condition that threatens your vision.

But there’s good news: You aren’t helpless in the face of GA. You can live a full, happy life with severe vision loss. What’s more, there are several things you can do to either slow the disease’s progression or work around it.

We asked ophthalmologist and retina specialist Ananth Sastry, MD, how people living with GA can take control of their health and defend against further vision loss. His nine recommendations won’t eliminate the hurdles ahead, but they might make them easier to navigate.

1. Start low-vision rehabilitation

“One of the most helpful ways to address the lifestyle-related consequences of having geographic atrophy is to see a low-vision specialist,” Dr. Sastry says.

Low-vision specialists are optometrists who are trained to help individuals with significant visual impairments — many who have geographic atrophy. They’re experts in assessing visual limitations and finding the appropriate instruments or technology to help a person regain function.

“In practical terms, that can be something as basic as prescribing simple magnifiers,” Dr. Sastry states. “It can also be complex. These days you can get wearable instruments that use augmented reality to map your peripheral vision onto your blind spots — to, essentially, recreate central vision.”

According to the American Academy of Ophthalmology, low-vision specialists are often part of a larger low-vision team. Those teams can include a range of experts, including:

• Ophthalmologists.
• Occupational therapists.
• Orientation and mobility specialists.
• Social workers and counselors.
• Assistive technology professionals.

Together, these providers can work with you to ensure you’re safe at home— anywhere else you choose to go.

2. Quit smoking or vaping

“Smoking is not only a risk factor for developing macular degeneration and other common eye conditions, but also for progression of the disease,” Dr. Sastry explains. “Smoking places oxidative stress on the retina. So cutting down or, ideally, quitting smoking altogether is the single best thing you can do to maximize your chances of sustaining your vision.”

Smoking cessation isn’t easy, but there are lots of different resources out there to help you. If none of the techniques you try are working, talk to your provider. They may be able to refer you to a specialist who can help.

3. Take AREDS2 supplements

The world of vitamins and supplements can get really murky really fast. But when it comes to geographic atrophy, the science is actually quite clear.

“Two different major studies show that nutritional supplementation with the AREDS2 formula provides some benefit in reducing the rate of progression of dry AMD,” Dr. Sastry says. “So, taking that supplement is one thing you can do to maximize your chances of prolonging your vision.”

AREDS2 supplements contain five main ingredients:

1. Lutein.
2. Zeaxanthin.
3. Vitamin E.
4. Zinc oxide.
5. Cupric oxide.

4. Eat nutritious food

There’s no such thing as a “geographic atrophy eating plan,” and a balanced diet can’t cure or reverse your condition. But it’s still important to eat well when you’re living with geographic atrophy.

“There’s some soft evidence suggesting that a Mediterranean diet could help minimize the progression of macular degeneration,” Dr. Sastry notes. “There’s also evidence that managing chronic health conditions like high blood pressure, high cholesterol and diabetes can help slow the disease’s progression. So, there’s really no downside to eating a healthy diet. It can even help your mental health.”

The same, he says, goes for exercise.

5. Exercise in a way that’s safe for you

As with diet, there isn’t a strong, scientific link between physical activity and geographic atrophy. But, at a bare minimum, we know that exercise can improve your overall health. It can also help you to manage chronic conditions that influence the progression of dry AMD.

Generally speaking, it’s best to engage in some form of exercise or activity for 150 minutes a week, spread over at least two or three sessions. What you do — and how hard you go — is up to you.

“There's no specific type of exercise that's going be the most beneficial for your vision, per se. And everyone’s different,” Dr. Sastry says. “Pick an activity you feel you can do safely, whether it's some kind of cardiovascular activity, weightlifting or resistance training.” Even a good gardening session can count.

If 150 minutes of physical activity a week isn’t a reasonable ask for you, start slow and build your way up. Any movement is a step forward.

But what if you’re living with a mobility impairment or find that your vision loss makes it hard to exercise with confidence? Talk to your low-vision specialist or an occupational therapist about it. They may be able to connect you with an adaptive exercise group, work with you on balance and fall prevention or suggest modifications that put your favorite flavor of fitness back on the table.

6. Reduce sun exposure

We should all be protecting our peepers against harmful UVA and UVB rays when we’re out in the sun. But it’s extra important if you have geographic atrophy because your retinas are already damaged. Here are a few ways to guard your eyes when you’re outside:

• Wear sunglasses with UV protection.
• Wear broad-brimmed hats or visors.
• Make use of umbrellas, trees and other sources of shade.
• Check the UV index before going out to prevent overexposure.
• Check to see if your medications increase photosensitivity.
• Apply a mineral sunscreen to the delicate skin around your eyes — including your eyelids — every day. If the sunscreen you use on your face burns your eyes, look into eye creams with SPF. Avoiding skin cancer in such a sensitive area is worth the trouble.

Remember: Water, sand and snow all reflect the sun’s UV rays. So, make sure you take these kinds of precautions all year round, no matter where you live.

7. Take fall prevention seriously

When our ability to see diminishes, it can sometimes take our balance, spatial awareness and proprioception with it. You may even notice changes to your posture or gait. That raises your risk of falling (and fractures) in a big way.

And it’s yet another reason why low-vision specialists are so helpful. They can recommend home modifications and assistive devices and address other medical conditions — like arthritis or hearing loss — that could impact the way you get around.

These interventions won’t just keep you upright, they’ll make it easier to preserve your social life — and with it, your mental health.

8. Continue seeing your providers

Dr. Sastry knows that coping with geographic atrophy can be challenging. Progressive vision loss is difficult to deal with, and it’s understandable that you may feel discouraged.

“Sometimes, it can seem like going to the doctor is a waste of time, since there aren’t really ways to make your vision better,” he concedes. But it’s important to keep seeing your retina specialist, your low-vision specialist and any other provider — like a therapist — who’s helping you navigate your condition.

Not every appointment will be earth-shattering. But Dr. Sastry says regular check-ups with a retina specialist — at least every six months — are key for two main reasons.

• Checking the progression of the disease. Generally speaking, Dr. Sastry says that vision loss is gradual enough that a person with geographic atrophy might not always notice it’s happening.
• Ensuring your dry AMD hasn’t converted to wet AMD. Dr. Sastry explains that dry macular degeneration can convert to wet macular degeneration at any time. And it’s usually best to start treatment as soon as your ophthalmologist detects the change. “These changes can sometimes be very subtle, which makes it difficult for the person living with the condition to notice or appreciate them,” he adds. “But your retina specialist can detect this change with an exam and imaging. Then, they can intervene, when appropriate, to ensure that further vision loss doesn't occur.”

Normally, a visit to your retina specialist every six months is enough. But there are some situations that require picking up the phone and getting seen. Call your provider if:

• You’re noticing significant changes to your vision in a short period of time.
• A new blind spot (scotoma) or distortion emerges.
• You’re experiencing pain. (It’s unlikely it’s the result of geographic atrophy, but it still needs to be evaluated.)

9. Keep up with the latest treatment advances

Regular visits to your retina specialist may start to feel routine after a while, especially if little about your care changes. But Dr. Sastry says that retina research is progressing rapidly. Getting informed about all the incredible work happening in the field may help keep your spirits high.

There are two areas of research Dr. Sastry thinks are worth keeping tabs on:

1. Stem cell therapies. Thanks to promising early research published in 2022, Dr. Sastry gets lots of questions about using stem cells to regenerate lost vision. It’s a topic that’s in the news — and worth following — but it isn’t ready for prime time yet. “Stem cell therapy is still at a highly experimental and preliminary stage of research,” he explains. “And it’s only being done at a small handful of institutions around the globe right now. It’s not yet an approved treatment for geographic atrophy.”
2. Pegcetacoplan and avacincaptad pegol. In 2023, the U.S. Food and Drug Administration (FDA) approved the first two drugs designed to treat (not reverse) geographic atrophy: Izervay™ (Avacincaptad pegol) and Syfovre™ (Pegcetacoplan). Dr. Sastry says these medications are injected into the eye every one to two months. Studies from the drug manufacturers showed that these treatments may slow the rate of growth. And more real-world data is being generated every day that we can use to evaluate these treatments’ risks and benefits.

The bottom line, according to Dr. Sastry: “It’s important to know that there’s hope. There are ways to live a good life with geographic atrophy, and I’m hopeful we’ll find better ways of treating the condition soon.”

The next scientific breakthrough may be right around the corner. But you won’t benefit from it if you aren’t making and keeping your eye appointments. In between visits, do what you can to preserve the vision you have and ask for help early and often. There’s no downside to improving your physical and mental health. And the upsides are more than worth the effort.