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. This condition greatly impairs your central vision. You’ll still have your peripheral vision — what you can see on all sides of the center.
Typically, geographic atrophy affects both eyes (bilateral). If you have geographic atrophy, you’ll have blind spots (scotoma) in your central view, and you’ll lose some sharpness of vision.
How common is geographic atrophy?
More than 8 million people in the world have geographic atrophy. This figure represents about 20% of all the people who have age-related macular degeneration.
An estimated 1 million people in the U.S. have geographic atrophy.
What are the symptoms of geographic atrophy?
Geographic atrophy is a late stage of macular degeneration. You might not notice symptoms in early stages or while the condition is in one eye only. When they do occur, geographic atrophy symptoms include:
- Loss of visual acuity (sharpness of vision).
- 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.
What causes geographic atrophy?
Geographic atrophy is the last stage of dry age-related macular degeneration. Researchers don’t know the actual cause of the eye changes that lead to geographic atrophy, but they think your immune system (complement cascade) plays a role. Genetic and environmental factors also 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.
There are risk factors for geographic atrophy. Risk factors make it more likely that a person will develop the condition.
What are the risk factors for geographic atrophy?
Risk factors for geographic atrophy include:
- Being age 60 or older.
- Being white.
- Having eyes that are light in color.
- Having biological family members who have macular degeneration or other genetic conditions that may affect the eyes.
- Being a smoker or a former smoker.
- Having a history of eating less healthy foods, especially fruits and vegetables. Dark green leafy vegetables are important to your eye health.
- Having a history of spending a lot of time in the sun.
- Having eyesight of 20/200 or worse, compared to the goal of 20/20 vision.
Other risk factors include having conditions such as:
What are the complications of geographic atrophy?
Vision loss due to geographic atrophy is, as of now, permanent. The loss of central vision can make it difficult to do some activities of daily living, including:
- Reading.
- Driving.
- Recognizing faces.
- Doing some types of crafts or hobbies.
How is geographic atrophy diagnosed?
An eye care provider will diagnose geographic atrophy through a combination of a comprehensive eye examination and diagnostic tests. They’ll also ask you about your symptoms, medical history and family medical history.
During the eye examination, your provider will be able to recognize signs of geographic atrophy.
What tests will be done to diagnose geographic atrophy?
To diagnose geographic atrophy, your eye provider may order:
- Fundus autofluorescence: This type of retinal imaging uses the ability of certain retinal substances, such as lipofuscin, to show without the use of injected dyes.
- Optical coherence tomography: This type of retinal imaging is noninvasive 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 electrical activity.
How is geographic atrophy treated?
The U.S. Food and Drug Administration (FDA) recently approved the first medication to treat geographic atrophy. Pegcetacoplan (SYOFOVRE™) is a monthly, or every other month, intraocular injection that slows the progression of the disease.
Other ways of managing geographic atrophy include:
- Visual rehabilitation: This features a variety of services that include prescription eyewear, obtaining visual aids like magnifying glasses and learning to manage activities of daily living.
- AREDS2 supplements: The Age-Related Eye Disease Study tested these antioxidant-containing supplements. Some healthcare providers use these to treat dry age-related macular disease. 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):Your surgeon replaces your lens with an IMT. The device magnifies things in your central vision and focuses them on other areas of your retina that are still working.
Complications/side effects of some treatments for geographic atrophy
Pegcetacoplan injections are very new. Manufacturer literature suggests that these side effects are possible:
- Eye pain.
- Subconjunctival hemorrhage, or bleeding in your conjunctiva.
- Floaters in your vitreous humor.
- Neovascularization of the eye.
Can geographic atrophy be prevented?
No. There’s no way to prevent geographic atrophy.
How can I lower my risk of developing geographic atrophy?
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 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 protective eyewear, such as yellow-tinted sunglasses to protect the macula in each of your eyes or safety glasses when you’re working.
- Eating a healthy diet, such as the Mediterranean diet, that includes dark leafy greens and fatty fish and limiting packaged foods and artificial fats.
- Getting regular physical activity.
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 outlook may be getting better, however, as there’s a new medication for treating geographic atrophy. Despite vision loss, the condition doesn’t affect life expectancy. Many people live full lives even with decreased vision.
When should I see my healthcare provider?
Follow your eye care provider’s suggestions on how often you should have eye examinations. Be sure to keep track of any differences in how well you see.
Always see your provider if you experience sudden vision loss or eye pain. In those cases, you should get immediate medical help.
What questions should I ask my provider?
You’ll probably have many questions if you have geographic atrophy. You might want to ask your provider these types of questions:
- What’s my diagnosis?
- How did you make this diagnosis?
- Is this condition hereditary?
- Should my family members be tested?
- When should I call you — what is an emergency?
- Am I eligible to participate in a clinical trial?
- What kind of treatment do you suggest?
- Can you help me find supportive services?
A note from Cleveland Clinic
Geographic atrophy affects your central vision. It’s exciting that there’s a new treatment for geographic atrophy, and research into treatments is ongoing. But it can be difficult to accept a diagnosis for a condition that has had a poor outlook. Your eye care provider is someone who wants to help. Follow their suggestions. Ask all the questions you need to ask so you have the information that will allow you to live fully. There are many visual aids, techniques and services that you can use.