Geographic atrophy (GA) is an advanced type of age-related macular degeneration (AMD), an eye condition that can cause the loss of your central vision. It’s sometimes called the “dry” version of AMD.
GA occurs when a part of your retina – the macula – grows thinner and loses its ability to function. It’s most common in people older than 60.
Age-related macular degeneration is the No. 1 cause of vision loss among older people. The loss of central vision can make it hard to see what’s in front of you. It can affect your ability to drive, read, watch television, or even recognize faces, but it virtually never causes total blindness.
GA typically affects both eyes (known as bilateral GA) though you can get it in only one. There is no cure for this condition, but there are treatment options that can slow progression.
Supplements for Advanced AMD
Certain vitamins and minerals may slow the progress of AMD if you have:
- Intermediate AMD
- A high risk of developing advanced-stage AMD
- Advanced AMD in just one eye
The supplements can provide a specific combination of nutrients that can counteract the buildup of a substance called drusen under your retina.
The AREDS2 supplements contain:
- Lutein and zeaxanthin, nutrients from plants that may protect your retina from light damage
- Vitamins C and E, antioxidants
- Zinc, a mineral that helps certain enzymes work
- Copper, because higher zinc levels can lower your copper levels
But if you have advanced AMD or GA in both eyes, the supplements don’t work as well. In this case, your doctor may suggest that the supplements be stopped.
Supplement side effects
Like any medication, supplements can come with potential side effects.
Stopping smoking is important for AMD and should be done before taking most supplements. Always check with your health care team before you take any nutritional supplements. They can help you figure out what’s best for your health.
Treatments for Geographic Atrophy
Your ophthalmologist or optometrist (eye specialists) are part of your eye care team. They can talk to you about the best geographic atrophy treatments and medications.
If you need treatment, a retina specialist who has additional training beyond ophthalmology will be responsible for your treatment evaluation and injection therapy.
You can also talk to your team about vision rehabilitation. In many cases, your team can suggest a low vision specialist who can give you a special prescription for your eyes, visual aids like magnifying glasses, or devices that help you complete daily activities.
GA medicines
The medicines avacincaptad pegol (Izervay) and pegcetacoplan (Syfovre) slow the progress of AMD. Both medicines are given every one to two months as a shot in your eye.
Izervay and Syfovre both work on your immune system, calming the response that causes damage to your retina. AMD is likely linked to problems with the complement system, which is part of your immune system.
When working correctly, the complement system helps fight germs that cause infection. But when it’s not working properly, it can cause chronic, low-level inflammation. And this may release byproducts in your blood and focal areas of the eye, including the macula.
Each medication targets a different molecule in your immune system.
Izerzay blocks a factor of the complement system called factor C5. In studies, the medicine slowed the progression of AMD anywhere from 14% to 20%. Syfovre works by blocking C3. But these medicines didn’t restore people’s lost vision or improve their eyesight, and that has been an area of concern for patients.
Side effects of GA medicines
Izervay and Syfovre are both injections given by your doctor and can come with some side effects.
How Is the Injection Given?
The thought of a shot in the eye might make you nervous. But learning about what to expect can calm your nerves.
Getting this shot takes about 10 minutes per eye. That’s because after the shot, your doctor will clean your eye and check to make sure everything has gone smoothly.
Your vision may be blurry after the shot. You’ll likely need someone to drive you home from your appointment. But your vision will get better over the next few days to week as the medications are absorbed.
GA Treatment Complications
American Society of Retina Specialists and other industry experts report a rare complication of blood vessel inflammation (retinal vasculitis) in 13 people who had treatment with Syfovre.
This condition may block blood flow to the retina and lead to blindness. But the complication occurred after the first shot of Syfovre. And the overall risk is about 0.01% chance per injection.
If you’re interested in Izervay or Syfovre, talk to your ophthalmologist about the benefits and the risks.
Insurance Coverage
Both Izervay and Syfovre can be costly medications. Without insurance or a patient assistance program, Izervay is about $2,000 per dose. Syfovre is about $2,200 per dose.
Syfovre may be covered by Medicare Part B if you meet certain requirements. Izervay also may be covered by Medicare Part B.
If you have private insurance, Izervay or Syfovre may be covered, depending on your plan. You may need to get prior authorization before you can begin treatment.
Izervay or Syfovre may offer copay assistance. If you’re interested in trying them, talk it over with your doctor. They’ll determine whether that’s a good choice and help you figure out your insurance coverage, too.
Light Therapy for GA
One of the newer treatments for geographic atrophy is light therapy, also called photobiomodulation.
Light therapy was tested in clinical trials on people with early to intermediate dry AMD who didn’t have much vision loss yet.
The Valeda Light Delivery System is one type of photobiomodulation device that can stimulate the cells in your eye to make more energy. Small parts of those cells – called mitochondria – generate energy.
You’ll sit at a machine at your ophthalmologist’s office for this treatment. Special red and infrared lights shine into your eyes when they are open and closed. But the process is painless and you won’t need dilating drops either.
Light therapy takes about four minutes per eye. Because the device doesn’t touch your eye, it’s called noninvasive. Photobiomodulation doesn’t typically affect your vision, and you can go back to normal activities right away, including driving.
Light therapy has been used for years to treat other conditions such as:
- Neurological problems
- Muscular conditions
- Inflammatory disorders
- Retinitis pigmentosa
- Diabetic retinopathy
In research, scientists found that people who had light therapy experienced:
- Slower progression of their AMD
- Less drusen buildup in their retinas
- Improved ability to read eye charts
Light therapy is still new and the long-term benefits and side effects of this treatment aren’t clear. A few people in the clinical trials developed wet AMD after treatment. This type of advanced AMD is a more serious and quickly progressing version of AMD than the dry form.
Because it’s so new, light therapy isn’t widely available. You might have to travel to find an ophthalmologist trained in the procedure, and the treatment requires repeat visits.
Medicare and private insurance do not cover light therapy now – again, because it’s so new. Your doctor’s office might offer a payment plan or know of support programs that would help with the cost.
Private programs that provide financial help in certain situations include:
- The Patient Access Network Foundation
- The National Organization for Rare Disorders
- Good Days
You might see red-light lamps or glasses for sale that you can use at home. But these aren’t FDA approved devices and may not safely treat your AMD.
New Treatments on the Horizon
New ways to treat geographic atrophy are being studied and tested in clinical trials.
These medications are experimental and under investigation. Your retina specialist can discuss these and other medications under study with you.
How to Access New GA Treatments
If you’re interested in trying newer GA treatments, you might consider joining a clinical trial. Your doctor may know of clinical trials and can help you decide if you’re a good fit.
You also can search for geographic atrophy clinical trials at ClinicalTrials.gov. By participating, you may receive cutting-edge treatments and help progress new therapies for GA.
The most important aspect of all GA care is for you to know about treatment options and ask your doctor what can be best for you.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
American Academy of Ophthalmology: “Geographic Atrophy,” “Vitamins for AMD,” “What to Know About Syfovre and Izervay for Geographic Atrophy,” “Geographic Atrophy — How to Get Paid for New Treatments,” “Eye Injections,” “FDA Authorizes Light Therapy for Dry AMD,” “Could Light Therapy Treat Dry AMD?” “Diabetic Retinopathy, Causes, Symptoms, Treatments.”
Cleveland Clinic: “Macular Degeneration,” Geographic Atrophy.”
Mayo Clinic: “Geographic Atrophy,” “Gene Therapy,” “Wet Macular Degeneration.”
Bright Focus Foundation: “Vitamins for Age-Related Macular Degeneration: Do You Have the Correct Formula?” “What to Know About Light Therapy for Dry Macular Degeneration,” “Emerging Treatments Offer New Hope for Dry and Wet Age-Related Macular Degeneration.”
Drugs.Com: “PreserVision AREDS 2 Side Effects,” “Izervay,” “Syfovre,” “Is Syfovre covered by Medicare?” “How Do Izervay and Syfovre Compare?”
Survey of Ophthalmology: “Gene and Cell Therapy for Age-Related Macular Degeneration: A Review.”
Journal of Vitreoretinal Diseases: “Retinal Vasculitis After Intravitreal Pegcetacoplan: Report From the ASRS Research and Safety in Therapeutics (ReST) Committee.”
Macular Society: “Syfovre FAQs and Next Steps for Dry AMD and Geographic Atrophy Treatment,” “Taking Part in Clinical Research.”
Medicare.gov: “Macular Degeneration Tests and Treatments.”
National Institutes of Health: “Supplements slow disease progression during late stage of ‘dry’ age-related macular degeneration.”
Syfovre.com: “GA Community,” “Frequently Asked Questions.”
Izervay.com: “Get Support.”
Florida Eye Clinic: “What to Expect During Valeda Treatment.”
American Society of Retina Specialists: “Patient Assistance Programs.”
ClinicalTrials.gov.
Retina Today: “The Complement System: A New Therapeutic Target.”
AREDS.org: “Age Related Eye Disease Studies.”
National Eye Institute: “Retinitis Pigmentosa.”
