Dr. Callahan is knowledgeable, dedicated, and explains clearly. She answered all my questions with patience. Her staff is pleasant, helpful, and always kind when I called with concerns.
Debbie Baker
Geographic Atrophy: Understanding Advanced Dry AMD
Symptoms and How GA Progresses
GA tends to develop gradually, and early changes can be subtle enough that many people do not notice them right away. As the atrophic patches expand toward the center of the macula, symptoms become more noticeable and begin to affect everyday tasks.
In early GA, the atrophic patches often form outside the fovea (the very center of the macula) and may not immediately affect your sharpest vision. You might notice that you need brighter light for reading, that small print is harder to make out, or that your vision seems slightly dim in certain lighting conditions.
As the patches grow toward the fovea, a blurry or blank area begins to appear in the center of your sight. Many people describe this as a smudge or gray spot that does not clear when they blink. This area grows slowly larger as more cells are lost.
The rate of GA progression varies from person to person. Some patients experience very slow expansion over many years, while others see faster growth. Larger initial lesion size, GA in both eyes, and certain genetic risk factors are associated with more rapid progression.
Our eye doctors measure lesion size at each visit using OCT (optical coherence tomography) and autofluorescence imaging to track your specific rate of change. This information helps us decide how often you need follow-up imaging and whether treatment may be appropriate for you.
GA primarily affects tasks that rely on sharp central vision, including reading, recognizing faces, driving, and doing detailed close-up work. Your peripheral (side) vision remains intact even in advanced cases, so you can still navigate your home, walk outdoors, and perform many everyday activities.
Many people with GA find that larger print, magnifying devices, and improved lighting help them continue reading and managing daily tasks. A low vision specialist can assess your specific situation and recommend tools that match your level of vision.
How We Diagnose and Monitor GA
Accurate diagnosis and consistent monitoring are the foundation of good GA care. Our eye doctors use advanced imaging tools to confirm the diagnosis, measure the size of atrophic areas, and track changes over time so that any meaningful progression is caught early.
Optical coherence tomography (OCT) creates a detailed cross-sectional picture of the retina, showing exactly where cell layers have thinned or disappeared. OCT confirms the presence of GA, measures the depth and area of atrophic patches, and allows our eye doctors to compare your retina across multiple visits.
OCT is painless and non-invasive. It takes only a few minutes and gives us precise structural information that a standard dilated exam alone cannot provide.
Fundus autofluorescence (FAF) imaging highlights the health of RPE cells by detecting natural fluorescence in the retina. Stressed RPE cells around the edges of atrophic patches often show increased autofluorescence, which can predict where the next area of cell loss is likely to occur.
By comparing FAF images across visits, our eye doctors can track where GA is expanding and how quickly the border is moving toward the fovea. This information helps guide decisions about monitoring frequency and treatment timing.
Patients with GA face an increased risk of also developing wet AMD. This risk is especially relevant for patients receiving complement-targeting treatments (the current approved GA medications), which have been associated with a higher rate of wet AMD conversion in clinical trials.
At each imaging visit, our eye doctors check carefully for signs of new abnormal blood vessel growth. At home, checking an Amsler grid each morning is a simple way to monitor for sudden changes. The Amsler grid is a pattern of straight lines used to detect distortion in your central vision. Sudden waviness, new blank areas, or rapid changes in your vision should be reported to us the same day, as these may signal wet AMD requiring prompt treatment.
Treatment Options for Geographic Atrophy
For most of the history of dry AMD, no approved treatment existed for GA. That changed with the approval of two new medications that slow the growth of atrophic patches. While neither treatment restores lost vision, slowing the expansion of GA may help preserve central vision for longer.
Pegcetacoplan was the first FDA-approved treatment for geographic atrophy. It works by targeting complement C3, a protein in the immune system's complement pathway that contributes to retinal cell damage in GA. The medication is delivered by injection into the eye on a monthly or every-other-month schedule.
In the OAKS and DERBY clinical trials, monthly dosing reduced GA lesion growth by approximately 21 percent and every-other-month dosing reduced it by approximately 16 percent at 12 months compared to a sham treatment group. These results represent a meaningful slowing of disease progression, though not a reversal of existing damage.
Avacincaptad pegol is the second FDA-approved treatment for GA. It targets complement C5, a different point further down the same immune pathway. It is administered by injection into the eye on a monthly schedule.
In the GATHER1 and GATHER2 clinical trials, avacincaptad pegol reduced GA lesion growth by approximately 27 percent in GATHER1 and approximately 14 percent in GATHER2 at 12 months. Like pegcetacoplan, it slows the expansion of atrophy without restoring vision that has already been lost.
Neither currently approved GA treatment improves visual acuity. Phase 3 trial data has not shown a meaningful visual benefit in treatment groups compared to sham groups. Both medications also carry an increased risk of converting dry AMD to wet AMD, which our eye doctors monitor for closely at every visit.
Your eye doctor will weigh the potential benefit of slowing lesion growth against the risks and the commitment of regular injections. Starting treatment before the fovea is involved may offer the best chance of preserving central vision over time, even if the measurable benefit is slower growth rather than sharper sight. This is a decision made together, based on your lesion location, growth rate, and personal priorities.
Frequently Asked Questions
The following questions address common points of confusion and practical decision-making for patients managing geographic atrophy.
No currently approved treatment reverses GA or restores retinal cells that have already died. The two approved medications slow the rate at which new cells are lost, but they do not repair existing damage. Research into stem cell-based therapies and retinal prosthetics is ongoing, but no such options are approved for clinical use as of 2026. Managing GA well means protecting the vision you have, not recovering what has already been lost.
When the atrophic patch reaches the fovea, you will likely notice a distinct blank or blurry spot right in the center of your vision that makes reading, recognizing faces, and seeing fine details significantly harder. However, symptoms alone are not always a reliable indicator of exactly where the lesion is. Our eye doctors confirm foveal involvement using OCT imaging, which shows the exact location and extent of tissue loss. Regular monitoring is the most reliable way to track this change before it becomes functionally significant.
Starting treatment while the fovea is still intact is worth discussing with your eye doctor, because slowing growth at that stage may delay the most impactful vision loss. However, both approved medications require ongoing monthly or every-other-month injections and carry a real risk of triggering wet AMD. Your eye doctor will review your lesion size, growth rate, and whether the fovea appears threatened in the near term to help you weigh whether the potential benefit justifies the risks and commitment involved.
GA does not cause total blindness. Your peripheral vision remains functional even in very advanced cases because GA primarily affects the central macula. You may lose the ability to read standard print or recognize faces at a distance, but you will still be able to see your surroundings, move around safely, and perform many daily tasks. Low vision rehabilitation, which connects you with magnifying tools, lighting adjustments, and adaptive strategies, can make a significant difference in your quality of life and independence.
Pegcetacoplan and avacincaptad pegol target different points in the complement pathway, so they do not work in exactly the same way. Their clinical trial results show overlapping but not identical ranges of lesion growth reduction, and their dosing schedules differ. Choosing between them involves practical factors such as your insurance coverage, the availability of the medication at your care facility, and how well a monthly versus every-other-month injection schedule fits your life. Our eye doctors will walk you through these considerations to help find the most appropriate option for your situation.
Whether you can continue driving depends on your current visual acuity and the location of your atrophic patches. If the fovea is not yet involved, your central vision may still meet the legal requirements for driving in Virginia. If the fovea is affected, your sharpest vision is reduced, and driving safely may no longer be possible. Our eye doctors will test your vision at each visit and advise you based on your actual results and the applicable standards for your license. Asking directly at your appointment is the best way to get a clear, current answer.
Partner with NewView Eye Center for Your GA Care
Geographic atrophy is a serious condition, but proactive monitoring and the right treatment plan can make a real difference in preserving the vision you have. At NewView Eye Center, our eye doctors combine advanced imaging, personalized care, and deep experience in retinal disease to help patients across Northern Virginia understand their condition and navigate their options with confidence. We are here to guide you every step of the way, from diagnosis through long-term management, so you can maintain your independence and quality of life.
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