About GA
Identifying GA
GA Is an Irreversible
Cause of Vision Loss1,2
Geographic atrophy (GA), an advanced form of dry age-related macular degeneration (AMD), is defined by the presence of sharply demarcated atrophic lesions of the retinal pigment epithelium and outer retina.3,4
Images courtesy of Dr. Mohammad Rafieetary (“Early AMD” and “Geographic Atrophy”, Dr. David Lally (Intermediate AMD), and Dr. Mark Dunbar (“Neovascular AMD”). Images are from separate patients.
Images courtesy of Dr. Mohammad Rafieetary (“Early AMD” and “Geographic Atrophy”, Dr. David Lally (Intermediate AMD), and Dr. Mark Dunbar (“Neovascular AMD”). Images are from separate patients.
Drusen Are a Hallmark of Early Disease
Drusen are a hallmark of early AMD, which can be observed by direct examination on color fundus photography (CFP) or on optical coherence tomography (OCT).1,2,5,6 Drusen come in various sizes. The larger the drusen, the greater the chance of progression to an advanced form of AMD such as GA.1, 2
Early AMD with drusen (white arrows). Pigmentary abnormalities are absent. Drusen are found between the retinal pigment epithelium basement membrane and Bruch’s membrane.3
Image courtesy of Dr. Mohammad Rafieetary
Early AMD with drusen (white arrows). Pigmentary abnormalities are absent. Drusen are between the retinal pigment epithelium basement membrane and Bruch’s membrane.
Degenerative Changes Occur in Intermediate Disease
Intermediate AMD is associated with extensive intermediate drusen (63-124 µm) or more than 1 large druse (≥125 µm).3 Pigmentary changes are also indicative of intermediate disease. Degenerative changes in the retinal layers may also be observed.3,4
Changes in visual function can occur before declines in visual acuity.7 Patients should be instructed to inform you of any sudden and/or persistent change in vision such as blurriness or distortion.8
See how disease progression impacts functional vision in the video here.
A
Image courtesy of Dr. Arshad Khanani
Immediate drusen (white arrows) can be visualized clearly on (A) OCT and (B) CFP.5,9 Pigmentary changes (wedges) visualized on CFP may precede atrophic changes.4,10 Images are from separate patients.
B
Image courtesy of Dr. Arshad Khanani
Drusen (white arrows) can be visualized clearly on (A) OCT and (B) CFP.5,9 Pigmentary changes (wedges) visualized on CFP may precede atrophic changes.4,10 Images are from separate patients.
Lesion Areas Enlarge in GA
Dry AMD progression to GA is characterized by the development of new atrophic lesions, growth of individual areas, or coalescence of multiple lesions. GA can be detected using various imaging modalities, such as OCT, which are commonly available in most clinics.1-3,11
A
Image courtesy of Dr. Mohammad Rafieetary
B
Image courtesy of Dr. Arshad Khanani
C
Image courtesy of Dr. David Lally
GA can be detected with most available imaging modalities. Atrophic lesions represent a loss of the retinal pigmented epithelium, overlying photoreceptors, and underlying choriocapillaris.2,12 Atrophic regions (white arrows) are represented on (A) CFP, (B) OCT, and (C) fundus autofluorescence imaging (FAF). Images are from separate patients.
Monitoring for Progression Is Critical
Lesion patterns can be predictive of slower or faster progressing disease and provide key data to inform management strategies.2,3 Patients can present with a wide range of visual symptoms; therefore it is critical to monitor patients for disease progression.4,7
Lesion Size
Slower
Progression
Progression
Faster
Progression
Progression
Small
Baseline Lesions
Baseline Lesions
Large
Baseline Lesions
Baseline Lesions
Location
Slower
Progression
Progression
Faster
Progression
Progression
Foveal
Non-Foveal
Focality
Slower
Progression
Progression
Faster
Progression
Progression
Unifocal
Multifocal
Lesion size, location, and focality may be predictive of the rate of lesion progression in GA. Smaller baseline lesions progress more slowly than larger baseline lesions. Foveal lesions progress more slowly than non-foveal lesions. Unifocal lesions progress more slowly than multifocal lesions.2,3
References
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- Patel PJ, Ziemssen F, Ng E, et al. Burden of illness in geographic atrophy: a study of vision-related quality of life and health care resource use. Clin Ophthalmol. 2020;14:15-28.
- Singh RP, Patel SS, Nielsen JS, Schmier JK, Rajput Y. Patient-, caregiver-, and eye care professional-reported burden of geographic atrophy secondary to age-related macular degeneration. Am J Ophthalm Clin Trials. 2019;2:1-6.
- Fleckenstein M, Keenan TDL, Guymer RH, et al. Age-related macular degeneration. Nat Rev Dis Primers. 2021;7(31):1-25.
- Velilla S, Garcia-Medina JJ, Garcia-Layana A, et al. Smoking and age-related macular degeneration: review and update. J Ophthalmol. 2013;2013:895147.
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- Curcio CA, Johnson M, Huang JD, Rudolf M. Apolipoprotein B-containing lipoproteins in retinal aging and age-related macular degeneration. J Lipid Res. 2010;51(3):451-67.
- Meleth AD, Mettu P, Agron E, et al. Changes in retinal sensitivity in geographic atrophy progression as measured by microperimetry. Invest Ophthalmol Vis Sci. 2011;52(2):1119-1126.
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- Coulthard LG, Woodruff TM. Is the complement activation product C3a a proinflammatory molecule? Re-evaluating the evidence and the myth. J Immunol. 2015;194(8):3542-3548.
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- Kumar-Singh R. The role of complement membrane attack complex in dry and wet AMD - From hypothesis to clinical trials. Exp Eye Res. 2019;184:266-277.