Geographic atrophy
At a glance
Atrophy in non-neovascular AMD affects reading and central visual function. Lesion location matters as well as area.
CAVE
- New distortion, haemorrhage or fluid suggests superimposed neovascular disease.
- Do not assume every deterioration is atrophy.
Clinical presentation
- Slow reading, paracentral scotomas and difficulty in low luminance may precede substantial acuity loss.
Diagnosis & investigations
- Confirm outer retinal and RPE loss on OCT, including hypertransmission, and use fundus autofluorescence to map lesion boundaries when useful. Record foveal sparing, multifocality and the distance of lesions from fixation; compare the same acquisition method over time.
- Check for haemorrhage or fluid suggesting concurrent neovascular disease. Assess reading speed, contrast-related difficulties, lighting needs and patient goals; relatively good letter acuity may coexist with major reading disability.
Differential diagnosis
- Inherited macular dystrophy, myopic atrophy and toxic or inflammatory maculopathy.
Treatment
- Offer smoking cessation support, low-vision rehabilitation, magnification, contrast and lighting optimisation early. Manage cataract or other treatable contributors rather than attributing all disability to GA.
- Explain realistic endpoints: an intervention that slows lesion growth does not restore lost photoreceptors. Any discussion of complement inhibition must include treatment burden, neovascular conversion and product-specific ocular adverse effects, alongside current local authorisation.
| Finding | Action | Timing / detail |
|---|---|---|
| Atrophy confirmed on multimodal imaging | Record foveal involvement, lesion distribution and serial change on comparable images | Measure reading function and daily difficulties; acuity alone underestimates disability |
| New distortion, haemorrhage or exudative OCT change | Investigate neovascular conversion urgently | Do not attribute every new symptom to slow atrophy progression |
| AREDS2 discussion | Use the established AMD-stage indications; discuss the secondary analysis suggesting slower foveal encroachment in non-central GA | Not a cure or restoration of lost retina; avoid beta-carotene-containing formulas in current/former smokers |
| Complement-inhibitor enquiry in Europe | Check the individual product and jurisdiction before discussing access | EMA Syfovre application refused in December 2024; this record does not establish the status of every other product |
Follow-up
- Plan clinical/OCT reassessment according to foveal proximity, fellow-eye nAMD, symptoms and the intervention being used; stable untreated disease commonly warrants review within 6–12 months, earlier if risk or symptoms change. New distortion or rapid loss requires urgent review between scheduled visits. Track function as well as lesion area.
Risk factors & context
- Assess the AMD phenotype in both eyes and smoking history.
- Atypical onset or distribution should prompt consideration of another macular disorder.
Complications
- Foveal involvement impairs central function; neovascular AMD may coexist.
- Assess reading, mobility and the need for low-vision support.
When to refer
- Urgent retina review for suspected conversion to neovascular AMD.
References 3
- AAO · Age-Related Macular Degeneration Preferred Practice Pattern ↗2025 · Diagnosis; management; patient education
- EMA · Syfovre (pegcetacoplan) ↗Refusal 16 December 2024 · record updated 30 October 2025 · Overview; reasons for refusal; application details
- NIH / NEI · Supplements and progression in non-central geographic atrophy ↗16 July 2024 · secondary analysis · Foveal progression; distinction from established AREDS indications
European guidance. Drug availability and authorisations must be checked locally.