Geographic Atrophy

What is geographic atrophy?

Geographic atrophy is a medical term that refers to later-stage cases of dry age-related macular degeneration (AMD). Macular degeneration is an eye condition that affects the macula of your retina. It dramatically affects your central vision — what you see straight ahead. You’ll still have your peripheral vision — what you can see on all sides of the center.

Typically, geographic atrophy affects both eyes (it’s bilateral). If you have geographic atrophy, you’ll have blind spots (scotoma) in your central view, and your vision will lose some sharpness.

How common is geographic atrophy?

More than 8 million people in the world have geographic atrophy. It affects around 20% of all people with age-related macular degeneration.

Experts estimate that around 1 million people in the U.S. have geographic atrophy.

What are the symptoms of geographic atrophy?

Geographic atrophy symptoms include:

• Loss of visual acuity (vision sharpness).
• Difficulty reading, driving, doing crafts or any other activity that relies on central vision.
• A dark spot, or blind spot, in your central vision.
• Difficulty seeing in dim light.
• Colors becoming drab or less vibrant.

Geographic atrophy is a late stage of macular degeneration. You might not notice symptoms in early stages or while the condition is in only one eye.

What causes geographic atrophy?

Geographic atrophy is the last stage of dry age-related macular degeneration. Researchers don’t know for certain what causes the changes in your eye that lead to geographic atrophy, but they think that part of your immune system called the complement cascade plays a role. Genetic and environmental factors likely play a part.

Geographic atrophy isn’t contagious. You can’t give it to someone like you can pass on germs for some diseases.

What are the risk factors for geographic atrophy?

Anyone can develop geographic atrophy, but some groups of people are more likely to, including people who:

• Are 60 or older.
• Are white.
• Have light colored eyes.
• Have a biological family history of macular degeneration or other genetic conditions that may affect their eyes.
• Smoke or used to smoke.
• Don’t eat a diet rich in fruits and vegetables. Dark green leafy vegetables are important to your eye health.
• Spend a lot of time in the sun.
• Have eyesight of 20/200 or worse (compared to typical 20/20 vision).

Other risk factors include having conditions such as:

• Malnutrition.
• Obesity.
• High blood pressure.
• High cholesterol.
• Diabetes.
• Coronary heart disease.

What are the complications of geographic atrophy?

Vision loss due to geographic atrophy is permanent. The loss of your central vision can make it difficult to do some activities, including: 

• Reading
• Driving.
• Recognizing faces.
• Doing your usual hobbies, activities or crafts.

How is geographic atrophy diagnosed?

An eye care specialist will diagnose geographic atrophy with an eye exam and other tests. Your provider will ask you about the symptoms you’re experiencing, medical history and family medical history.

What tests will be done to diagnose geographic atrophy?

To diagnose geographic atrophy, your eye care specialist may order:

• Fundus autofluorescence: This type of retinal imaging uses the ability of certain retinal substances, such as lipofuscin, to show up (autofluoresce) without the use of injected dyes.
• Optical coherenece tomography: This type of retinal imaging is non-invasive and uses reflected light.
• Microperimetry: Microperimetry is a type of visual field test that offers retinal imaging.
• Multifocal electroretinography: This type of exam exposes your retina to light and measures the electrical activity.

How is geographic atrophy treated?

The U.S. Food and Drug Administration (FDA) recently approved the first medications to treat geographic atrophy. Pegcetacoplan (SYOFOVRE™) and avacincaptad pegol (IZERVAY™)are intraocular injections that can slow geographic atrophy’s progression. Your eye care specialist will inject these medications directly into your eye either monthly or every other month.

Your eye care specialist might suggest other ways to manage how much geographic atrophy, including:

• Visual rehabilitation: You might need special prescription eyewear, or visual aids like magnifying glasses to help you participate in your daily routine.
• AREDS2 supplements: The Age-Related Eye Disease Study tested these antioxidant-containing supplements. Some healthcare providers use these to treat dry AMD. An AREDS1 formula contains the same ingredients along with beta-carotene. However, beta-carotene is associated with lung cancer in people who smoke. AREDS2 contains lutein, zeaxanthin, vitamin E, zinc oxide and cupric oxide.
• Implantable miniature telescope (IMT): A surgeon will replace your eye’s natural lens with an IMT. The device magnifies objects in your central vision and focuses them on other areas of your retina that are still working.

Geographic atrophy treatment side effects

Pegcetacoplan and avacincaptad pegol injections are very new, so experts are still studying their effectiveness and risks. Side effects can include:

• Eye pain.
• Subconjunctival hemorrhage (bleeding in your conjunctiva).
• Floaters in your vitreous humor.
• Neovascularization of the eye.

Can geographic atrophy be prevented?

There’s no way to prevent geographic atrophy because you can’t prevent the macular degeneration that causes it.

You may be able to lower your risk of developing geographic atrophy by addressing modifiable risk factors. Modifiable risk factors are things you can change, unlike your age or ethnicity.

You may lower your risk by:

• Not smoking. Try to quit smoking if you smoke.
• Managing chronic conditions like diabetes, high blood pressure, obesity and high cholesterol.
• Wearing sunglasses with a yellow tint to protect your eyes when you’ll be in the sun.
• Wearing safety glasses or the correct protective eyewear for all work, sports or hobbies.
• Following an eating and physical activity plan that’s healthy for you.

What can I expect if I have geographic atrophy?

In general, the outlook for geographic atrophy hasn’t been good in terms of vision, but the disease progresses differently for each person. The new medications that treat geographic atrophy have shown promising results.

Geographic atrophy isn’t fatal, and it won’t affect your life expectancy.

When should I see my healthcare provider?

Your eye care specialist will tell you how often you’ll need eye exams. Talk to your eye care specialist if you notice any changes in your eyes or vision.

Always see your provider if you experience sudden vision loss or eye pain. In those cases, you should get immediate medical help.

Which questions should I ask my provider?

• Do I have geographic atrophy or another eye issue?
• Which tests will I need?
• Am I a good candidate for the new medications that can treat geographic atrophy?
• How often will I need follow-up eye exams?
• Am I eligible to participate in a clinical trial?
• Which changes in my eyes should I watch out for?
• Can you help me find supportive services?

A note from Cleveland Clinic

It’s exciting that there are new treatments for geographic atrophy, and research into treatments is ongoing. Still, it can be scary to find out you have a condition that can permanently affect your vision. Your eye care specialist will help you understand what you should expect, and what the best treatments are to help you mange geographic atrophy.