With the recent availability of specific geographic atrophy (GA) treatments, it is important to reconsider which prior teachings or commonly held beliefs regarding GA are really true and which are fiction. Misconceptions among patients and eyecare providers (ECPs) create confusion, delays in treatment, and ultimately worse visual outcomes. This article separates fact from fiction to provide a clearer picture of geographic atrophy—what it is, what it isn’t, and what patients and caregivers should know.

FICTION: GA will cause total blindness

FACT: It is shocking how many patients with AMD, even those who have been diagnosed with the disease for years, still live in fear that it will make them lose all of their vision. As ECPs, we know that AMD may lead to devastating loss of central vision, which may meet the legal definition of blindness (e.g., best-corrected VA ≤20/200), but that it does not lead to total blindness. However, we often forget to emphasize this to our patients, assuming that they already know. As simple as it seems, this should be something that we consistently bring up with our AMD patients.

FICTION: Dry AMD is the good kind of AMD

FACT: A common idea among patients is that there exists a good kind of AMD and a bad kind of AMD, with dry being good and wet being bad. The reality is that all AMD is bad. While wet or exudative AMD can progress quickly and cause a rapid loss in central vision due to formation of fibrovascular scar, dry AMD can result in the same devastating loss of central vision through the formation of GA.

In addition, even patients with early and intermediate stage dry AMD can experience loss of visual function and clarity such as delayed dark adaptation, reduced contrast sensitivity, and metamorphopsia that make certain tasks such as night driving, reading, or doing fine detailed tasks difficult, frustrating, or impossible.^1,2

FICTION: GA progresses slowly

FACT: While GA progression varies among patients, in general it moves faster than we previously thought. With GA therapies now available, much more attention has been paid to the disease and the speed at which is progresses. On average, from time of diagnosis to time of central vision loss in a patient with GA is only 2.5 years.³

FICTION: There is no cure for GA, so nothing can be done

FACT: Until recently, treatment options were limited to supportive care and lifestyle changes. In 2023, the FDA approved the first treatment for GA—pegcetacoplan (Syfovre)—followed by avacincaptad pegol (Izervay). These drugs don’t cure GA, but they have been shown to slow its progression. Additionally, lifestyle changes like smoking cessation, following a diet rich in leafy greens and omega-3 fatty acids, and managing cardiovascular health can help preserve vision longer. Regular monitoring with an eye care specialist is also crucial.

FICTION: I referred my patient to a retina specialist for their GA, so there is nothing more I need to do.

FACT: Retina specialists focus on managing the retina disease itself, but they are often not well versed in making recommendations for best optical correction, low vision aids, and may not focus on managing ocular comorbidities such as glaucoma or even dry eye—a seemingly innocuous disease, but one that can further impair the visual quality of a patient or lead to more discomfort from treatments such as intravitreal injections.

Additionally, an alarming number of patients with severe visual impairments are never referred to a low vision specialist.^4,5 The primary ECP should evaluate how a patient’s activities of daily living are affected by GA and make appropriate recommendations for the patient or refer the patient to a provider who can do so.

Final Takeaway

Geographic atrophy is a serious and often misunderstood eye condition. While it doesn’t cause total blindness, it can dramatically impact central vision and day-to-day functioning. The good news is that recent medical advances and increased awareness are changing the landscape for those affected. Separating fact from fiction is essential—not just for patients, but for families, caregivers, and health care providers. With proper management, support, and emerging treatments, individuals with GA can maintain independence and quality of life longer than ever before.

References

1. Enger C, Alexander MF, Fine SL. Contrast sensitivity in age-related macular degeneration. Arch Ophthalmol. 1988;106(1):55-57.
2. Owsley C, McGwin G, Clark ME, et al. Delayed rod-mediated dark adaptation Is a functional biomarker for incident early age-related macular degeneration. Ophthalmology. 2016;123(2):344-351.
3. Keenan TD, Agrón E, Domalpally A, et al. Progression of geographic atrophy in age-related macular degeneration: AREDS2 Report Number 16. Ophthalmology. 2018;125(12):1913-1928.
4. Coker MA, Huisingh CE, McGwin G, et al. Rehabilitation referral for patients with irreversible vision impairment seen in a public safety-net eye clinic. JAMA Ophthalmol. 2018;136(4):400-408. 
5. Dalzotto K, Banghart M, Thomas-Virnig C, Mondal S. Assessment of low vision referrals before and after establishment of a low vision program at an academic medical center. Optom Vis Sci. 2022;99(12):885. 

Jessica Haynes, OD, FAAO, FORS, Dipl ABO, practices at Charles Retina Institute in Germantown, Tennessee.

This editorial content was supported via unrestricted sponsorship