One of the hottest topics in eye care today is geographic atrophy (GA) secondary to age-related macular degeneration (AMD). This is because GA affects approximately 8 million people globally¹ and 1 million people in the United States² alone, yet there were no treatments available to fight the disease until last year. As of 2023, we now have two FDA-approved drugs to slow the progression of GA: avacincaptad pegol intravitreal solution (Izervay, Astellas) and pegcetacoplan injection (Syfovre, Apellis).

Currently, it is thought that GA constitutes about 35% of all advanced-stage AMD cases.³ That number is likely going to rise as awareness, diagnosis, and physician documentation of the disease increases and insurance coding for treatments becomes streamlined. Eyecare professionals should be prepared to not only carefully and routinely screen for GA, but also to discuss it with their high-risk patients before signs appear. 

Early detection yields the best opportunity to slow progression of GA. The slower the progression, the longer the patient can main-tain functioning vision. Baseline visual acuity, patient motivation, and compliance should all be considered when selecting GA treatment. Also, it is important to consider risk-benefit assessment and fellow-eye status. 

Whereas in the past a diagnosis of GA signaled unavoidable vision loss, we can now give our patients hope. The following are key topics for the GA patient conversation:

• Know Your Risk Factors. People over age 60, those who smoke, and those with a family history of AMD are at the highest risk of developing GA.⁴ Other risk factors include obesity, hypertension, high cholesterol, and heart disease.⁵  

• Healthy Habits Reduce Risk. Patients should be advised to quit smoking, maintain a diet low in salt and saturated fats,^4-5 and exercise regularly. AREDS2 supplements should also be considered.⁶

• Annual Eye Exams Are Vital. The importance of identifying and addressing GA early cannot be understated. The disease is relentless—in just 2 years, patients are likely to lose the ability to drive. Within 6 years, they can be legally blind.⁷  It has also been noted that atrophic lesions that are larger, multifocal, extrafoveal, and irregularly shaped progress quicker.⁸

• Be Aware of Symptoms. Signs of GA may include spotty
vision while reading, increased trouble seeing in dim light, dulling of colors, and progressive blurriness in the center of vision.

• How We Can Detect GA. Regular use of an Amsler grid can help catch early signs, but there is no substitute for dilated fundus exams or color fundus photography. Advanced imaging via optical coherence tomography (OCT) and fundus autofluorescence allows for assessment of potential progression from AMD to GA.⁴ 

• Treatment Options Exist. Both avacincaptad pegol and pegcetacoplan have been proven to slow the progression of GA by targeting the complement system.^{9, 10} These medications are administered intravitreally once monthly or once every other month. Now that we have established a permanent J-code for both drugs, insurance coverage is available for them.

Mary Beth Yackey, OD practices at the Cincinnati Eye Institute in Ohio and Kentucky, where she is a member of the vitreoretinal team. She is a paid speaker for Apellis and Astellas, and a consultant for OcuTerra, Optos, Notal Vision, Novartis, Reliance Ophthalmic, and Topcon.

REFERENCES: 

1. Boyer D, Schmidt-Erfurth U, van Lookeren Campagne M, et al. The pathophysiology of geographic atrophy secondary to age-related macular degeneration and the complement pathway as a therapeutic target. Retina. 2017:37(5):819-835.

2. The Eye Diseases Prevalence Research Group. Prevalence of Age-related macular degeneration in the United States. Arch Ophthalmol. 2004;122(4):564–572.

3. Klein R, Klein BE, Knudtson MD, et al. Fifteen-year cumulative incidence of age-related macular degeneration: the Beaver Dam Eye Study. Ophthalmol. 2007;114(2):253-262.

4. Age-Related Eye Disease Study Research Group (AREDS). Risk factors associated with age-related macular degeneration. A case-control study in the age-related eye disease study: AREDS Report Number 3. Ophthalmol. 2000;107:2224-2232. 

5. Seddon JM, Widjajahakim R, Rosner B. Rare and common genetic variants, smoking, and body mass index: progression and earlier age of developing advanced age-related macular degeneration. Invest Ophthalmol Vis Sci. 2020;61(14):32. 

6. AREDS2 Research Group, Chew EY, Clemons T, et al. The Age-Related Eye Disease Study 2 (AREDS2): study design and baseline characteristics (AREDS2 report number 1). Ophthalmol. 2012;119(11):2282-2289.

7. Chakravarthy U, Bailey CC, Johnston RL, et al. Characterizing disease burden and progression of geographic atrophy secondary to age-related macular degeneration. Ophthalmol. 2018;125(6):842-849.

8. Fleckenstein M, Mitchell P, Freund KB, et al. The progression of geographic atrophy secondary to age-related macular degeneration. Ophthalmol. 2018;125(3):369-390.

9. Jaffe GJ, Westby K, Csaky KG, et al. C5 inhibitor avacincaptad pegol for geographic atrophy due to age-related macular degeneration: a randomized pivotal 2/3 trial. Ophthalmol. 2021:128 (4)576-586.

10. Heier JS, Lad EM, Holz FG, et al. Pegcetacoplan for the treatment of geographic atrophy secondary to age-related macular degeneration (OAKS and DERBY): two multicentre, randomised, double-masked, sham-controlled, phase 3 trials. Lancet. 2023;402(10411):1434-1448.

THIS EDITORIALLY INDEPENDENT CONTENT IS SPONSORED BY ASTELLAS