What Is Geographic Atrophy?
Geographic atrophy (GA) is one of two kinds of advanced age-related macular degeneration (AMD). It’s an eye disease that damages cells in the central part of your retina called the macula. Late-stage dry AMD is another name for it.
You can have geographic atrophy and wet AMD (the other kind of advanced AMD) in the same eye, but they’re different conditions. Wet AMD happens when abnormal blood vessels grow and leak into the back of your eye. This typically causes vision loss much faster than dry AMD.
With geographic atrophy, light-sensitive cells and tissue in your retina slowly die. This process leads to blurriness or blind spots in your central vision. You use this part of your eye to read, drive, or focus directly on things like people’s faces or the words in this sentence.
About 20% of people with dry AMD get geographic atrophy. Older age and genetics are the main risk factors. Doctors see it most often in people 60 and older who have a family member with macular degeneration or another genetic eye condition.
People of all races and ethnicities can get geographic atrophy, but it’s more common in White people or those of European descent. Your odds of getting it go up if:
- You’re a smoker or former smoker.
- You eat a lot of unhealthy foods.
- You have a health condition like obesity, high blood pressure, diabetes, or heart disease.
While researchers have yet to pinpoint the exact cause of geographic atrophy, the body’s complement pathway likely plays a role. It triggers proteins that work with your immune system to keep you healthy. Treatment that targets this part of the immune system may help slow disease progression, but there’s no cure.
Symptoms of Geographic Atrophy
Some people have clear sight for years. But once geographic atrophy sets in, it typically worsens your fine vision over time. Your symptoms largely depend on the location and severity of your lesions and whether both eyes are affected.
Geographic atrophy impacts everyone differently, but it rarely affects your peripheral or side vision. That means you won’t go totally blind if this is the only eye disease you have. But central vision loss can make some tasks more difficult.
Common symptoms of geographic atrophy include:
Difficulty reading. At first, letters or numbers may go missing. Later, whole words may disappear. If you have a big blank spot in your central vision, you may not be able to see entire pages of books or any of the eye chart on the wall at your doctor’s office, for example.
Trouble recognizing faces. You use your macula when you look right at someone. But blind spots in your central vision can make it hard to clearly make out facial details, especially if you’re looking at someone from far away or in a dim room.
Problems with contrast and color sensitivity. Even if you have good visual acuity (say, you can read letters on an eye chart), geographic atrophy can make it harder to tell the difference between certain colors or shades of light and dark.
Other symptoms of geographic atrophy include:
- Blurry, foggy, or distorted vision
- Grey or washed-out areas in your central vision
- Trouble seeing clearly at night or in low-light settings
- Difficulty with detail-oriented hobbies such as sewing, cards, or playing golf
- “Losing” objects from your field of vision
- Tripping over curbs or running into things due to central vision loss
People with geographic atrophy or other kinds of vision loss sometimes see people, animals, or objects that aren’t there. This is called Charles Bonnet syndrome. These visual hallucinations aren’t dangerous, but you should tell your doctor about them. They’ll want to rule out other health problems as the cause.
Diagnosis and Testing
While your optometrist (regular eye doctor) or ophthalmologist (eye doctor who specializes in complex cases) may be the first to spot signs of geographic atrophy, they might send you to a retina specialist for further testing or future checkups.
If the eye doctor thinks you have geographic atrophy or wants to measure disease progression, they may give you the following:
Dilated eye exam. You’ll get special eye drops to widen your pupil so your doctor can get a good look at your retina and macula. Geographic atrophy shows up as light patches in the back of your eye.
Visual acuity test. You’ll look at a reading chart to measure how many letters you can see clearly from a distance. If you use prescription glasses or contacts, you’ll wear them for the test. Keep in mind people with geographic atrophy can have good visual acuity but still have other symptoms of vision loss.
Reading speed. You may read slower than folks with less advanced forms of age-related macular degeneration.
Amsler grid. This is a square made up of horizontal and vertical lines. If you have geographic atrophy, you may see dark patches, distorted areas, wavy lines, or blank spots in in the grid.
Retinal imaging. Your eye doctor may use special cameras to take pictures of the back of your eye. These photos give a detailed look at the tissue and cells in and around your retina, which shows the size, location, and severity of your geographic atrophy lesions.
Imaging for geographic atrophy may include:
- Color fundus photography
- Optical coherence tomography
- Fundus autofluorescence
- Fluorescein angiography
Other visual imaging. You may get other tests that apply heat (microperimetry) or light (multifocal electroretinography) to your retina to measure how well the light-sensitive cells in your retina respond.
My Diagnosis Story
By Bob O’Connell
The easiest place for me to start is in 2005. At the time, I was 47 and living in Tulsa, OK. I went to see my ophthalmologist for my annual checkup. I didn’t have any vision problems, but he told me there was something going on in my retina. He didn’t know what it was and suggested I get evaluated by someone with specialized training in retinal diseases.
I already had plans to move back to the Philadelphia area, so I scheduled my follow-up at Wills Eye Hospital in the fall of that year. I’ve always believed in the importance of finding the best doctor regardless of where they’re located. And according to my research, they have some of the top eye doctors in the country.
My retina specialist originally told me I had a type of macular dystrophy. He recommended that I take certain vitamins and come back to see him every year. Maybe 2 or 3 years later, shortly before I turned 50, he transitioned the diagnosis to age-related macular degeneration.
A few years after my diagnosis, I took my mother to an ophthalmologist. She was 86 at the time, and her doctor diagnosed her with macular degeneration. That confirmed to me that whatever was going on in my eyes was probably genetic.
Somewhere between 2014 to 2016, the images my eye doctor took of my retina every year showed evidence of geographic atrophy. I even printed out the pictures to explain to my family what was going on. You could see that the macular degeneration was encroaching more and more on the center of my left retina.
Right now, I don’t have any central vision in my left eye. I couldn’t tell you exactly when that happened, but it’s been at least 4 or 5 years. What’s that like? Well, if I closed my right eye and looked directly at your nose, I wouldn’t be able to see your face.
I have geographic atrophy in both eyes, but my right eye is hanging in there. I can still read and see pretty well when I have both eyes open. But I can also tell things are gradually changing.
For example, I struggle with color contrast every day. I first noticed it when I was reading a document. Someone told me to go over the parts highlighted in yellow. But I couldn’t tell the difference between yellow and white.
Light grey on a white background (like the text on many websites) is also a problem. I change the contrast when I read on an electronic device so that the background is black and the text is white, which helps.
Until recently, there was no treatment for geographic atrophy. But after living with this disease for almost 20 years, there’s finally some medication that may help. And within the next couple of weeks, I expect to get the newly approved pegcetacoplan (Syfovre) injection.
The hope is that these eye shots will slow degeneration in my right eye. Current medical treatment can’t restore the retinal cells that’ve already died in my left eye.
My diagnosis was kind of depressing at first. Even to this day, I get anxious at my annual visit with the retina specialist. But at 65, I would tell my younger self this: 18 years from now you’ll still be able to drive; you’ll still function independently; you’ll find ways to adapt.
I also tell folks, especially those over 50 with a family history of macular degeneration, to be very diligent about getting their eyes checked regularly and managing other health conditions. When I was diagnosed, I had no symptoms to suggest I had a problem.
Questions for Your Doctor
Write down everything ahead of time, noting the most important things at the top. It’s easy to forget what you want to ask when you’re sitting in the exam room. Schedule a follow-up appointment with your doctor if there isn’t enough time to go over everything in one visit.
Here are some questions to get you started:
- Can I have both wet and dry AMD?
- How fast does geographic atrophy progress?
- Does geographic atrophy in one eye mean I’ll get it in the other?
- How often do I need to get my eyes checked?
- How can healthy lifestyle changes like diet, exercise, and supplements help my eyes?
- Are my family members at a higher risk of geographic atrophy? Should they get tested?
- Should I see a retinal or macular degeneration specialist?
When it comes to managing geographic atrophy and daily life, ask questions such as:
- Can I live independently if I lose all of my central vision?
- Will I still be able to read? If so, for how long?
- Does geographic atrophy ever cause total blindness?
- When should I go to low vision rehabilitation?
- How can I learn more about low vision services?
When it comes to treatment, you may want to ask:
- What are all my treatment options?
- If I start getting shots for geographic atrophy, how long will I need to get them?
- Can I get treatment for wet and dry AMD at the same time?
- Can shots for geographic atrophy raise my odds for wet AMD?
- Are there clinical trials I can join?
Treatment for Geographic Atrophy
Until recently, there weren’t any medical treatments for the dry form of AMD. But in 2023, the FDA approved two drugs to treat geographic atrophy. They’re both shots you get in your eye every month or every other month. These drugs have been shown to slow disease progression, but they can’t restore vision loss.
Injections for geographic atrophy include:
- Pegcetacoplan (Syfovre)
- Avacincaptad pegol (Izervay)
There’s ongoing research into new therapies to slow or stop geographic atrophy, including drugs and stem cell treatment. Find more information about clinical trials for macular degeneration at clinicaltrials.gov or ask your doctor about studies you can join.
What to Expect With Geographic Atrophy
At first, you may have small lesions far away from the center of your macula that don’t cause big vision changes. But you’ll continue to lose more retinal cells and tissue over time. It’s hard to predict how fast or slow this will happen. Your eyesight may gradually decline over many years or within months.
Now that there are treatments for geographic atrophy, you may have a better outlook. But right now, there isn’t a cure or a way to reverse vision loss caused by the disease.
Almost everyone with geographic atrophy has difficulty reading at some point. But many still see well enough to get dressed or cook on their own. As your blind spots grow, however, some activities may become frustrating or unsafe.
For example, people with central vision loss often say they don’t feel comfortable driving, especially at night. And while not everyone with geographic atrophy will go legally blind (when your vision is worse than 20/200 even with corrective lenses), some do. And that means you’ll be required to stop driving.
Remember that geographic atrophy doesn’t cause total vision loss, and most people who have it remain independent. But you may have to learn new ways or use low vision aids to navigate daily life.
How Your Geographic Atrophy May Change Over Time
You may start out with areas of atrophy next to healthy spots of retina. But geographic atrophy usually gets worse the longer you have it. After a while, your lesions may grow together, which causes bigger blind spots or greyed-out areas of your central vision.
At some point, geographic atrophy can damage the cells in the very center of your macula or fovea. This is the part of your eye where your central vision is sharpest.
Taking Care of Yourself
If you’ve been diagnosed with geographic atrophy or you’re concerned you might be in the future, you can take steps to help protect your eyes and overall health.
Try these tips:
Get good nutrition. Load up on leafy greens and colorful fruits and vegetables. Antioxidants from plants such as kale, spinach, and yellow or orange peppers, for example, have been shown to promote eye health. Omega-3 fatty acids from fish or flax and chia seeds may also protect your eyes.
If you smoke, quit. People who smoke or are around secondhand tobacco smoke are more likely to get geographic atrophy or to progress faster once they’re diagnosed.
Ask about supplements. The AREDS2 vitamins may help lower the odds of developing late-stage age-related macular degeneration, particularly wet AMD. They may not slow the progression of geographic atrophy, but they’re worth asking your doctor about, especially if you still have good vision in one eye.
Exercise regularly. Physical activity boosts your overall well-being, helps you maintain a healthy weight, and guards against other health conditions.
Check in with your doctor. You may need dilated eye exams or retinal imaging every 6 months to 12 months. Your eye doctor will let you know how often to come in.
Tips for Living With Geographic Atrophy
Along with healthy lifestyle changes and medical treatment, there are many things you can do to live well with geographic atrophy.
Here are some ways to adapt to vision loss and boost your quality of life:
Go to low vision rehabilitation. It’s a good idea to see a low vision specialist early in your diagnosis, but you can go to low vision rehab at any point. You’ll learn how to adapt to vision loss and manage daily life, either through behavioral changes or with the help of low vision tools and adaptive devices.
Low vision aids may include:
- Stronger glasses or different types of corrective lenses or magnifiers
- Computers or tablets
- Assistive tools on your smartphone
- Tools for cooking, reading, or chores
- Special lights or lamps
- Magnifiers to help you sew or do other detail-oriented hobbies
Join a support group. You may feel better if you talk to others who know what you’re going through. Ask your doctor or low vision specialist to connect you with people who have geographic atrophy or age-related macular degeneration. You may also find in-person or online support groups through:
- American Macular Degeneration Foundation
- BrightFocus AMD Community Circle
- Macular degeneration Facebook groups
Take care of your emotional health. Some people with geographic atrophy experience symptoms like anxiety and depression. Ask your doctor to refer you to a mental health professional who works with people who have vision loss.
Information for Caregivers
Your support and understanding can go a long way to help your loved one adapt to life with central vision loss. Here are steps you can take:
- Learn all you can about geographic atrophy and central vision loss.
- Ask your loved one if they need help, especially when it comes to reading or driving.
- Be patient. Someone with geographic atrophy may take longer to finish certain tasks.
- Urge them to work with a low vision specialist or use low vision aids.
- Help them socialize. Tag along to events if your loved one feels uneasy going alone.
To grasp what it’s like to live with central vision loss, ask the eye doctor to give clear examples of how geographic atrophy affects your loved one’s sight. You can also learn more about the condition through websites such as BrightFocus Foundation, Prevent Blindness, and the American Macular Degeneration Foundation.
Navigating Insurance and Cost Assistance
Doctor visits, low vision rehabilitation, and medications are usually covered by private health insurers and government-sponsored programs. How much you’ll pay depends on the type of health insurance plan you have, what tests or services you get, and what facility you go to.
For example, Medicare (state-run health insurance for older adults) typically covers 80% of the cost of treatment for eye diseases like age-related macular degeneration, including new medications for geographic atrophy. If you don’t have additional coverage, you may be responsible for the rest of the bill.
Whether you’re insured or not, help is available to cover your out-of-pocket health care costs. Ask your doctor to connect you with a social worker who can help find resources or a benefit specialist in your area.
You can also:
- See if you’re eligible for a discount on Syfovre. Find out more by calling the AppellisAssist program at 888-273-5547.
- Look into financial assistance through the Izervay My Way program. Call 888-256-9929.
- Use the Medicine Assistance search engine tool to look for resources.
- Visit the NeedyMeds website.
The National Institute on Aging’s Benefits CheckUp website may also help you find ways to pay for health care, medicine, groceries, housing, utilities, or other costs.