Geographic Atrophy (GA): What It Is, Why It Happens, and How It's Treated
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Geographic atrophy (GA) is the late stage of dry age-related macular degeneration (AMD), damaging the macula and causing permanent central vision loss; side vision usually remains, so it does not cause total blindness. Causes include aging, genetics and immune activity. It mainly affects people over 60 and smokers. It cannot be cured, but FDA-approved injections can slow it. [1] [2]
What the Research Says
Monthly avacincaptad pegol slowed lesion growth by 14% at 12 months. In GATHER2, 448 people with geographic atrophy were randomly assigned to avacincaptad pegol 2 mg or sham injections. The mean rate of lesion growth was 0.336 mm/year with treatment versus 0.392 mm/year with sham. Macular neovascularization occurred in 7% of the treated group and 4% of the sham group. Exudative (wet) macular neovascularization occurred in 5% and 3%. (Khanani et al., Lancet, 2023) [2]
The benefit continued at two years. Over two years, lesion growth was 14% lower with monthly and 19% lower with every-other-month avacincaptad pegol than with sham, with choroidal neovascularization in 11.6% of treated versus 9.0% of sham-treated eyes. (Khanani et al., Ophthalmology, 2025) [3]
Pegcetacoplan also slows growth over the long term. In eyes with subfoveal GA followed for up to 36 months, pegcetacoplan reduced lesion growth by 21% with monthly dosing and 19% with every-other-month dosing compared with projected sham. (Dhoot et al., Clin Ophthalmol, 2026) [4]
Pegcetacoplan slowed lesion growth over two years but did not improve vision. In the OAKS and DERBY trials of 1,258 people aged 60 and older, monthly pegcetacoplan slowed lesion growth at 24 months by 22% and 19%, and every-other-month dosing by 18% and 16%, compared with sham. Key measures of visual function did not differ, and new-onset exudative (wet) AMD was reported in 11% and 13% with monthly treatment versus 2% and 4% with sham. (Heier et al., Lancet, 2023) [5]
Lutein and zeaxanthin were a sound replacement for beta carotene in eye supplements. In a 10-year follow-up of 3,882 people in AREDS2, lutein/zeaxanthin was linked to a lower risk of progression to late AMD (hazard ratio 0.91; 95% CI 0.84-0.99), while beta carotene was linked to higher odds of lung cancer (odds ratio 1.82; 95% CI 1.06-3.12). (Chew et al., JAMA Ophthalmol, 2022) [6]
What Is Geographic Atrophy?
Geographic atrophy is the medical term for late-stage dry age-related macular degeneration. It specifically targets the macula, the small central portion of your retina that is responsible for your central vision, everything you see straight ahead when you look directly at an object. [1]
When you have geographic atrophy, the cells in the macula begin to waste away or thin out. This creates blind spots, known as scotomas, in the very center of your view. While GA dramatically affects your ability to see fine details, it typically leaves your peripheral vision (side vision) intact. Most cases are bilateral, meaning the condition eventually affects both eyes. [1]
Geographic atrophy: the advanced, final stage of dry macular degeneration.
Macula: the center of the retina used for sharp, detailed vision.
Scotoma: a blind spot or dark area in the field of vision.
Bilateral: affecting both eyes.
Geographic atrophy is relatively common among people with macular degeneration, affecting about 20% of them. More than 8 million people worldwide live with GA, including an estimated 1 million in the United States. [1] For the earlier stages of the disease, see Dry Macular Degeneration.
What Are the Symptoms of Geographic Atrophy?
Because geographic atrophy is the final stage of a slow-progressing disease, you might not notice symptoms early on, especially if the condition is only in one eye. As it advances, the impact on daily life becomes significant. You may find it increasingly difficult to read small print, drive safely, or do hobbies like sewing or crafts that need fine detail. Colors may begin to look drab, washed out, or less vibrant than they used to.
Central blind spots: a dark or blurry patch in the middle of whatever you are looking at.
Difficulty in dim light: significant trouble seeing or reading in low-light environments.
Loss of sharpness: text and faces appear fuzzy or indistinct.
Color changes: bright colors seem faded or difficult to distinguish.
What Causes Geographic Atrophy?
Geographic atrophy is the final stage of dry age-related macular degeneration. While researchers are still working to understand the exact trigger, they believe a part of the immune system called the complement cascade plays a major role. This system, which normally helps the body fight infections, may begin to attack and damage healthy retinal cells in the macula. It is not contagious; it is caused by a combination of your genetics and your environment over many years. [1]
Who Is Most at Risk?
While anyone can develop GA as they age, certain groups have a higher statistical risk: [1]
Age and appearance: people aged 60 or older, people of white ethnicity, and people with light-colored eyes.
Genetics: a family history of macular degeneration is one of the strongest risk factors.
Lifestyle: smoking (or a history of smoking), a diet low in fruits and vegetables, and frequent sun exposure.
Health conditions: obesity, high blood pressure, high cholesterol, diabetes, and coronary heart disease.
GA is one of several eye conditions that become more common with age. For the bigger picture, see Common Age-Related Eye Problems, Cataracts, and Glaucoma.
How Is Geographic Atrophy Diagnosed?
An eye care specialist, such as an ophthalmologist or a retina specialist, diagnoses geographic atrophy through a comprehensive eye exam and specialized imaging tests. They will review your medical history and ask about any vision changes you have noticed. To confirm the diagnosis and track progression, they may use:
Optical coherence tomography (OCT): a non-invasive test that uses light waves to take cross-section pictures of your retina.
Fundus autofluorescence: imaging that makes certain substances in the retina glow without injected dyes, helping doctors see areas of cell loss.
Microperimetry: a test that maps the sensitivity of different areas of your retina to light, identifying where blind spots are forming.
Multifocal electroretinography: a test that measures the electrical response of your retinal cells to light stimulation.
How Is Geographic Atrophy Treated?
Until recently, there were no medical treatments to stop geographic atrophy. The FDA has now approved the first medications designed to slow its progression. [1]
FDA-approved medications
Pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay) are intraocular injections, meaning a specialist injects the medicine directly into the eye, usually every month or every other month. They do not restore lost vision, but they can slow how quickly the blind spots grow. [1] Possible side effects include eye pain, bleeding in the white of the eye (subconjunctival hemorrhage), floaters, and abnormal new blood vessel growth in the eye (neovascularization). Because these drugs are new, long-term effectiveness and risks are still being studied. Like any eye injection, they can rarely cause a serious eye infection (endophthalmitis), retinal detachment or eye inflammation; pegcetacoplan has been linked to rare retinal vasculitis that can cause severe vision loss. Get care right away for eye pain, redness, light sensitivity or sudden vision changes after an injection. [1] [3]
Supportive treatments and visual aids
Because the vision loss from GA is permanent, management often focuses on making the most of your remaining sight:
Visual rehabilitation: working with a specialist to learn to use magnifying glasses, high-contrast digital readers, and other visual aids. [1]
AREDS2 supplements: a formula of lutein, zeaxanthin, vitamin E, zinc oxide, and cupric oxide that some providers use for dry AMD. [1] The earlier AREDS formula also contains beta carotene, which is linked to lung cancer in people who smoke. [1]
Implantable miniature telescope (IMT): a surgical option in which a tiny telescope replaces the eye's natural lens and magnifies images onto the healthy parts of the retina. [1]
Can Geographic Atrophy Be Prevented?
There is currently no way to completely prevent geographic atrophy, because you cannot stop the underlying macular degeneration process entirely. However, you can lower your risk by focusing on the risk factors you can change:
Quit smoking: smoking is a risk factor and one of the most important you can change.
Eat a healthy diet: include plenty of fruits and vegetables, especially dark green leafy vegetables.
Protect your eyes from the sun: wear sunglasses outdoors.
Manage your health: keep blood pressure, cholesterol, and blood sugar within healthy ranges, and keep up with regular eye exams after 60.
Conclusion: Living With Geographic Atrophy
Geographic atrophy is a serious, late-stage eye condition that causes permanent central vision loss. While it can be life-altering, it is not fatal and does not lead to total darkness, because side vision typically remains. The approval of new medications is a turning point, offering hope that the disease's progression can be slowed. If you have been diagnosed with GA, the most important steps are to keep regular appointments with a retina specialist, quit smoking, and explore the wide range of visual aids that can help you stay independent.
Comfort and reassurance: A diagnosis of geographic atrophy can be overwhelming, but you are not alone. With treatments now available and advanced visual rehabilitation, many people with GA continue to live active, engaged lives. Early detection is key, so stay diligent with your eye exams.
When to seek emergency care: If you experience sudden vision loss or intense eye pain, seek immediate medical attention at an emergency room or from an eye specialist. These can be signs of serious complications that require urgent treatment.
Frequently Asked Questions
What is geographic atrophy in simple terms?
It is the advanced stage of dry macular degeneration where the center of the retina (the macula) thins out, causing permanent blind spots in your central vision. [1]
Does geographic atrophy cause total blindness?
No. It affects central vision, but most people retain their peripheral (side) vision, meaning they can still see objects to the sides of their center view.
Is there a cure for geographic atrophy?
There is no cure that restores lost vision, but there are now FDA-approved treatments that can slow the progression of the disease. [1]
What are the new treatments for geographic atrophy?
Two injections, pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay), are approved by the FDA and are injected into the eye to slow the growth of blind spots. [1]
How often are the injections given?
They are typically given by a retina specialist once a month or every other month. [1]
How much do the injections slow geographic atrophy?
In the GATHER2 trial, monthly avacincaptad pegol slowed lesion growth by 14% compared with sham at 12 months. [2] In a 36-month analysis of eyes with subfoveal GA, pegcetacoplan reduced lesion growth by 21% with monthly dosing and 19% with every-other-month dosing compared with projected sham. [4] They slow growth; they do not restore lost vision.
Can I drive with geographic atrophy?
As the disease progresses, driving often becomes difficult or unsafe due to the loss of central vision. Discuss your vision and driving safety with your eye doctor.
Are AREDS2 supplements effective for geographic atrophy?
AREDS2 supplements (lutein, zeaxanthin, vitamin E, zinc oxide, and cupric oxide) are used by some providers for dry AMD, but their effectiveness once GA has already developed is more limited. The original AREDS formula contained beta-carotene, which is linked to lung cancer in people who smoke. [1]
Is geographic atrophy hereditary?
Having a family history of macular degeneration is a significant risk factor for developing the condition. [1]
Does smoking affect geographic atrophy?
Smoking, current or past, is a risk factor, and it is one of the most important ones you can change. [1]
What is a scotoma?
A scotoma is a blind spot or a dark area in your field of vision caused by damage to the retina.
Can I still read with geographic atrophy?
Reading becomes very difficult as the central vision fades, but many people continue to read using high-powered magnifiers, large-print books, or digital audiobooks.
What is the complement cascade?
It is a part of the immune system that normally helps fight infection; researchers believe it plays a major role in geographic atrophy by damaging healthy cells in the macula.
Will geographic atrophy affect my life expectancy?
No. Geographic atrophy only affects your vision; it is not fatal and does not affect life expectancy. [1]
What is an implantable miniature telescope?
It is a tiny device surgically implanted to replace the eye's natural lens, magnifying images onto the healthy parts of the retina and bypassing the damaged macula. [1]
How common is geographic atrophy?
More than 8 million people worldwide have it, including an estimated 1 million in the United States, and it affects about 20% of people with age-related macular degeneration. [1]
Related Reading on Rinnit.com
Dry Macular Degeneration: Complete Guide to Symptoms, Causes & Treatment: the earlier stages that can lead to geographic atrophy.
Common Age-Related Eye Problems: What They Are, Why They Happen, and How They're Treated: an overview of eye conditions that become more common with age.
Bull's Eye Maculopathy: What It Is, Why It Happens, and How People Live With It: another condition that affects the macula.
Glaucoma: Silent Threat to Vision and Cataracts: What You Need to Know: two more common eye conditions in older adults.
References
Cleveland Clinic Staff. Geographic Atrophy: Symptoms, Causes & Treatment. Cleveland Clinic. Last updated April 5, 2023. https://my.clevelandclinic.org/health/diseases/24890-geographic-atrophy
Khanani AM, Patel SS, Staurenghi G, et al. Efficacy and safety of avacincaptad pegol in patients with geographic atrophy (GATHER2): 12-month results from a randomised, double-masked, phase 3 trial. Lancet. 2023;402(10411):1449-1458. PMID 37696275. https://doi.org/10.1016/S0140-6736(23)01583-0
Khanani AM, Danzig CJ, Heier JS, et al. Avacincaptad Pegol for Geographic Atrophy Secondary to Age-Related Macular Degeneration: Two-Year Efficacy and Safety Results from the GATHER2 Phase 3 Trial. Ophthalmology. 2025;133(4):451-465. PMID 41407269. https://doi.org/10.1016/j.ophtha.2025.12.011
Dhoot DS, Garg SJ, Brown DM, et al. Efficacy of Continuous Pegcetacoplan Treatment for Subfoveal Geographic Atrophy in Age-Related Macular Degeneration: 36-Month Results from OAKS, DERBY, and GALE Open-Label Extension. Clin Ophthalmol. 2026;20:579237. PMID 42164977. https://doi.org/10.2147/OPTH.S579237
Heier JS, Lad EM, Holz FG, et al. Pegcetacoplan for the treatment of geographic atrophy secondary to age-related macular degeneration (OAKS and DERBY): two multicentre, randomised, double-masked, sham-controlled, phase 3 trials. Lancet. 2023;402(10411):1434-1448. PMID 37865470. https://doi.org/10.1016/S0140-6736(23)01520-9
Chew EY, Clemons TE, Agrón E, et al. Long-term Outcomes of Adding Lutein/Zeaxanthin and ω-3 Fatty Acids to the AREDS Supplements on Age-Related Macular Degeneration Progression: AREDS2 Report 28. JAMA Ophthalmol. 2022;140(7):692-698. PMID 35653117. https://doi.org/10.1001/jamaophthalmol.2022.1640
Medical disclaimer
This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have about a medical condition. Never disregard professional medical advice or delay seeking care because of something you have read here. If you think you may have a medical emergency, call your doctor or emergency services immediately.
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