Attendees at this year’s American Academy of Optometry (AAO) meeting were met with a surprise: a quick game of $1 or Mystery Gift!
The gifts didn’t come free, though—recipients had to face the gauntlet of answering a question about geographic atrophy (GA)!
Geographic atrophy may only affect a small percentage of the patient population, but new treatments as of 2023 mean that eyecare professionals now have the tools to slow the progression and postpone irreversible vision loss.
How much did your colleagues know about GA when we put them on the spot?
Watch your colleagues’ and friends’ full reactions on TikTok!
Who knows their stuff when it comes to GA—and who needs to brush up on their knowledge?!
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So what is geographic atrophy?
Geographic atrophy is an advanced form of dry age-related macular degeneration (AMD) characterized by localized, sharply demarcated atrophy of the retinal pigment epithelium (RPE).1 Each year in the United States, an estimated 160,000 new cases of GA are added to the 1 million already diagnosed with the condition.2
This prevalence is only expected to increase as the population ages; the average age of a patient with GA is 79 years, and the prevalence increases from 0.15% at 50 years of age to 2.91% at 80.3,4
Geographic atrophy is seen clinically as well-delineated round or oval areas of hypopigmentation, which allow for increased visibility of the choroidal vessels—these typically will appear in the parafoveal region initially but will progress into the fovea with time.5,6
What should optometrists know about GA progression?
The most commonly used imaging modalities to track GA progression include ocular coherence tomography (OCT), fundus autofluorescence (FAF), near-infrared (NIR) reflectance imaging, and color fundus photography.
Key biomarkers of GA progression include:
- Choroidal hypertransmission signaling nascent geographic atrophy lesion as the RPE begins to attenuate
- Hyporeflective wedges bordering the zone of nascent GA
Lesion characteristics associated with faster progression include:7
- Extrafoveal lesions
- Multifocal lesions
- Large lesions
- Presence of hyperfluorescence
- Bilateral disease
We know GA is a heterogeneous disease and unpredictable—therefore, it's critical to detect and assess the risk factors of GA progression to make timely referrals. The median length of time it takes for an extrafoveal geographic atrophy lesion to encroach on the fovea is 2.5 years.
Can GA be treated?
This brings us to the exciting part—yes! Two treatments for GA were approved in 2023—pegcetacoplan (Syfovre, Apellis Pharmaceuticals, Waltham, MA) and avacincaptad pegol (Izervay, Astellas, Cranbury, NJ). These complement inhibitor intravitreal injection therapies are designed to slow GA progression.
This makes it especially crucial for ODs to detect GA and refer for treatment early because tissue damage or vision lost to geographic atrophy is irreversible.
