If you’ve been diagnosed with dry age-related macular degeneration (AMD), you may be concerned about geographic atrophy (GA). This is the most advanced form of dry AMD, and it can cause severe vision problems. Although you can’t reverse geographic atrophy, you can take extra steps to slow its development and progression.

This article will cover six key facts about geographic atrophy, including risk factors, symptoms, treatment, and outlook. To learn more about your individual risk, talk with your eye doctor.

1. Geographic Atrophy Is the Most Severe Form of Age-Related Macular Degeneration

Dry AMD is an eye disease that affects the retina — the light-sensitive tissue at the back of your eye. The center of the retina is known as the macula. This tissue is responsible for your central vision, which helps you sharply focus your vision to read, recognize faces, and drive safely.

AMD begins as drusen — yellow deposits of fats and proteins beneath the retina. Over time, low-grade inflammation begins attacking and damaging the eyes. This eventually leads to geographic atrophy.

Geographic atrophy, the most advanced and severe form of AMD, can create scotomas (permanent blind spots) in your vision. These spots form where pigmented cells that nourish the retina have atrophied (wasted away) and died. Imaging tests show that spots or lesions of atrophy can look like a map. This is where the term “geographic atrophy” comes from.

According to the BrightFocus Foundation, around 1 million Americans are living with geographic atrophy. Worldwide, experts believe up to 5 million people are affected. This disease also is responsible for causing about 20 percent of legal blindness.

2. Certain Factors Raise Your Risk of Geographic Atrophy

Several factors are associated with an increased risk of geographic atrophy. People with a family history of AMD are more likely to develop the disease themselves. This is because your genetics — traits passed down from your parents — also play a role. Doctors and researchers have found at least two specific genes associated with AMD and geographic atrophy.

Age also plays a role in risk. Studies show that the average age of a person diagnosed with geographic atrophy is 79 years. A person’s GA risk quadruples every 10 years, starting at age 50.

The sun releases ultraviolet rays that can damage your skin and eye cells. Geographic atrophy tends to develop in people who spend lots of time outside in the sun. You’re also more likely to develop geographic atrophy if you have light-colored eyes or skin. It’s important to wear sunglasses or a hat to protect your skin and eyes when spending time outside.

Your overall health also directly affects your eye health. People who smoke cigarettes or smoked in the past are more likely to develop geographic atrophy. This is because smoking raises blood pressure and negatively affects heart health.

Along the same lines, people who don’t get regular exercise and who eat unhealthy diets are also at risk of geographic atrophy. These unhealthy lifestyle choices contribute to high cholesterol levels and obesity (higher body weight), which are known GA risk factors. On the other hand, nutrients called antioxidants, which can be found in dark leafy greens and many colorful vegetables, are important for controlling inflammation and preventing cell damage.

Read more about what causes geographic atrophy.

3. Geographic Atrophy Can Cause Permanent Vision Problems

Geographic atrophy develops slowly over time. In fact, many people with the early stages of GA don’t notice any symptoms. This is because atrophy lesions form on the outside part of the macula and spread toward the center. Your vision may start to blur, and you may need more light to read a book or menu. If you have a healthy eye with normal vision, it can usually compensate for the eye affected by AMD and geographic atrophy.

Once the lesions reach the fovea — the center of the macula — you may notice more vision problems. Permanent blind spots can develop in late stages. You may also have a hard time telling apart colors of similar shades, and colors can appear washed out or dull. Other GA symptoms include:

• Large black spots in your central vision
• Difficulty seeing in dim lighting or the dark
• Loss of central vision, making it hard to complete daily tasks like driving and cooking
• Trouble with bright lights and glares

If you start noticing any GA symptoms, talk to your doctor. They can refer you to an ophthalmologist — a specialist who treats eye diseases. They’ll perform an eye exam and order imaging tests to look for atrophy in your macula.

Read more about what people with geographic atrophy see.

4. People With Geographic Atrophy Are More Likely To Develop Depression

Living with a progressive disease like AMD and geographic atrophy can negatively affect your quality of life and mental health. Some people with geographic atrophy develop anxiety and depression from their vision loss. You may find it harder to connect with others while socializing or feel a loss of independence. Everyday tasks can become frustratingly difficult when you don’t have your full vision.

It’s important to note that not everyone with geographic atrophy will experience changes in mental health. If you’ve noticed new feelings of anxiety or depression, be sure to talk with your doctor. They can connect you with mental health professionals to help.

5. Two Treatments Are Approved for Geographic Atrophy

Until 2023, no dry AMD treatments had been approved by the U.S. Food and Drug Administration (FDA). Thanks to the hard work of doctors and researchers, there are now two medications for treating geographic atrophy that develops as a result of AMD.

Pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay) work by controlling inflammation associated with geographic atrophy. Specifically, these medications block the complement system — a complex part of the immune system.

Normally, the proteins C3 and C5 help activate this system to destroy invading pathogens like bacteria. People with geographic atrophy have an overactive complement system that attacks drusen in the eyes, which creates inflammation that leads to eye damage. Researchers found that blocking C3 and C5 proteins helps reduce inflammation and stops the complement system from damaging retinal cells.

At this time, there’s no way to reverse the damage done by geographic atrophy. Pegcetacoplan and avacincaptad pegol are FDA-approved to treat geographic atrophy that develops as a result of AMD.

If you have intermediate dry AMD, your eye doctor may recommend taking supplements or making lifestyle changes. You may also be eligible to join a clinical trial to try cutting-edge treatments for geographic atrophy.

6. Some People With Geographic Atrophy Become Legally Blind

Unfortunately, geographic atrophy is a progressive disease that can have a poor prognosis (likely outcome). Once atrophy occurs, it can’t be reversed, and some people become legally blind. Eye doctors diagnose legal blindness in people with 20/200 vision or worse. This means that they must be 20 feet from what people with normal vision can see at 200 feet. One study that included 137 people with geographic atrophy reported that 12.4 percent of these participants were regustered as legally blind, and 5.8 percent were being evaluated for blindness.

If you’ve been diagnosed with dry macular degeneration or geographic atrophy, it’s important to work closely with your eye doctor. They’ll create a treatment plan and recommend lifestyle changes to slow your disease progression. Eating a healthy diet, quitting smoking, and getting regular exercise can all help treat geographic atrophy and protect your vision.

Talk With Others Who Understand

On myAMDteam, the social network for people with age-related macular degeneration and their loved ones, members who understand life with age-related macular degeneration come together to share support, advice, and stories from their daily lives.

Are you living with geographic atrophy? How has it affected your vision? What treatments have you been prescribed? Share your experience in the comments below or by posting on your Activities page.