Retinal Conditions
Geographic Atrophy (Advanced Dry AMD)
Age-Related Macular Degeneration (AMD) has different stages and types including mild AMD, intermediate AMD, wet AMD, and atrophic AMD. Wet AMD and atrophic AMD are both advanced forms of the disease which can cause vision loss, and it is possible to have both advanced forms in the same eye.
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What Does Atrophy Mean in AMD?
The retina is like the film in a camera and lines the back wall of the inside of your eye. Right behind the retina is a barrier layer called the retinal pigment epithelium (RPE) which is also important for the health of the retina. In atrophic AMD, the RPE cells become sick and degenerate, leaving patches of tissue with poor vision. When atrophic AMD starts, the vision is often decreased in a non-specific manner. The vision is less clear, color and contrast are affected, and glasses do not help. This is equivalent to the film in the camera wearing thin right in the center but still functioning.
When atrophic AMD progresses further, it can result in geographic atrophy (GA), where discrete patches of the retina stop functioning entirely. This results in dark or missing spots in the vision. Atrophic AMD can sometimes cause black “ink spots” that are briefly visible when waking up or when the lighting changes suddenly. Patients will also sometimes experience their vision “jumping” because their eye is rapidly moving around, trying to find a spot with clear vision but struggling because healthy areas of retina are irregular and patchy.
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Location & Progression of Geographic Atrophy
If GA is located away from the center of the retina, it may have very little impact on visual acuity, as measured on the eye chart, even if the affected region is large. Sometimes non-central GA will affect the peripheral vision in a way that impacts driving safely. If GA is located in the center of the retina, even a small patch of GA may profoundly limit visual acuity. GA usually progresses over time.
On average, GA enlarges at a rate of about 2.5 mm² per year, but in some patients, the atrophy progresses slower or faster. Your BARA doctor can explain how your GA is progressing, often with the aid of specialized retinal images that can highlight areas of atrophy.
​​Complement Inhibitor Injections
In 2023, the FDA approved two medications for treatment of GA. Syfovre (pegcetacoplan) and Izervay (avacincaptad pegol) are both injected into the eye at regular intervals in order to slow down the rate of GA progression. Both drugs belong to a category called complement inhibitors, which slow down apoptosis (cell death) in the retina. The two drugs differ in their risk/benefit profiles; your BARA doctor can discuss these nuances and how we make our recommendations for choice of medication for treatment of GA. It is important to recognize that no available FDA approved treatment can stop or reverse the progression of GA. Even with treatment, we expect the disease to progress. The goal of treatment is to help preserve the remaining central vision for as long as possible.
For more information about injections into the eye, please see our handout on Intravitreal Injections.
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Photobiomodulation
In November of 2024, the FDA approved the Valeda Light Delivery System for treatment of non-central GA. The Valeda has been available in Europe since 2019. The photobiomodulation technology uses multiple wavelengths of light delivered in a series of 9 sessions over 3-5 weeks to stimulate retinal cells in order to reduce oxidative stress and inflammation. Each treatment session lasts a few minutes. The series of 9 treatments may be repeated at 4 month intervals.
FDA approval was based on the LIGHTSITE III clinical trial, a double-masked clinical trial in which 100 patients received either light therapy or sham therapy for 2 years. Patients who received the Valeda treatment demonstrated decreased progression to geographic atrophy (advanced dry AMD) and some patient demonstrated improved vision. Experts in our field continue to discuss the available data and its implications, and as with any new therapy, we expect additional data in the near future will guide and refine the use of the technology.
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No head-to-head data currently exist to compare complement inhibitor injections to Valeda light therapy for non-central GA. Your BARA retina specialist can discuss the pros and cons of each treatment and help make a recommendation, which often depends on the specific characteristics of each case.