What Is Geographic Atrophy?
Geographic atrophy, or GA, is an advanced form of age-related macular degeneration (AMD). There are two types of AMD, dry or wet, and the diagnosis depends on what causes the vision loss Dry AMD, which is by far the most common type, occurs when parts of the retina are damaged. It causes a gradual loss of vision. Wet AMD occurs when blood vessels grow and leak beneath the retina.1 It is less common, but causes more severe vision loss.
When the dry form of AMD becomes more advanced, it can lead to GA. For most people with GA, the first symptoms are a lack of peripheral vision in both eyes, which then progresses to impaired central vision.2 For others, the first symptoms may be the opposite: a loss of central vision that then spreads to the peripheral.3
GA is one of the top causes of blindness in the country, affecting more than 1 million people in the United States. Around 20 percent of people who have AMD are eventually diagnosed with GA.4,2 There is no difference in the number of GA diagnoses between men and women, but GA is less likely to occur in people of Asian descent.2
Understanding Your GA Diagnosis
What Causes GA?
While GA can happen to anyone as they get older (it’s most common in people over the age of 60), there are certain aspects—both genetic and environmental—that can raise your risk:2
- Family history of AMD
- Smoking (either now or in the past)
- Severely poor vision (particularly worse than 20/200)
- Coronary heart disease or high cholesterol
- Taking thyroid hormones
How is GA diagnosed?
Your ophthalmologist can diagnose you with GA by doing a physical exam of your eye, either dilating your pupil or taking a photo of your retina.1 During the exam, they may see the telltale sign of GA, which is drusen (yellow deposits in the retina area). If the GA is more advanced, the doctor will also see atrophic lesions, or areas in the retina where there is no pigment or tiny blood vessels.2
Because the early signs of GA can be subtle, there is often a delay in diagnosis. Many people with early-stage GA can still see with relatively normal vision, but they might not be as sensitive to contrast or have a harder time reading.2 This subtle shift in vision can be easy to write off as nothing major, or as just “something that happens as you get older.” Many people with GA report that they didn’t have a sense of urgency about getting their eyes checked out.5
How to Manage and Treat GA
While GA can progress at different rates for different people, it tends to be slow and can take years to become severe.2 The goal of treatment isn’t to stop or reverse GA, which is unfortunately not possible, but instead to slow its progression and help you keep as much vision as possible.2
A big area of focus is on visual rehabilitation, which is learning how to stay independent and have a high quality of life even if your eyesight is impaired.6
While in the past there weren’t any medical treatments specifically for GA, new treatments have been approved to slow the progression of the disease. Notably, there are also other drugs in clinical trials which are designed to reduce inflammation or oxidative stress, slowing down how fast the GA progresses.2
Living with GA
Feelings of worry for the future and a perceived lack of options with a GA diagnosis can have a big impact on your well-being. People who have GA are more likely than those without to have mental health issues such as depression.7
One key thing to keep in mind is that even if your disease progresses to legal blindness, that doesn’t mean you are without vision. You may lose the ability to focus on details without magnification, but may still be able to have some vision and sight. Further still, it can help to think of GA as a “severe vision loss” as opposed to “complete blindness.”8
How to Care for Your Mental Health
The isolation from others that may naturally occur when you lose vision can make mental health issues worse. Knowing you aren’t alone and seeing how others still live full lives after a GA diagnosis can help you have a better quality of life.9 Ask your ophthalmologist for resources about finding a local or online GA or AMD support group so you can meet and hear the stories of others with your diagnosis.
People with GA aren’t the only ones who can benefit from support—caregivers to people with GA can also be at risk for burnout. Signs of burnout include withdrawal, feeling helpless, fatigue, depression, and trouble sleeping.10 If you’re experiencing any of these symptoms, be sure to talk to a mental health professional to make sure you have healthy coping strategies. Consider looking into caregiver support groups as well to help feel more connected and heard.
Strategies for Living Well
Depending on the type of vision loss you’re experiencing, there are options available to help you go through your daily life in as normal a way as possible. If you’re experiencing any of the below difficulties, consider these strategies:8
Get a stronger prescription for your glasses or switch to large-print books and newspapers. This is especially easy to do if you use, or switch to, an e-reader or tablet.
Consider devices called optical magnifiers, which can enlarge the print on normal-sized text, can be a huge help.
Try finding ways to utilize better lighting and illumination so you can see better in these conditions. You may need to adjust your lifestyle in some ways—such as avoiding driving at night.
When you’re moving around, scan your eyes back and forth to compensate for trouble with peripheral vision.
Whatever vision difficulties you may be experiencing, it’s important to talk to your doctor about how to adapt and keep a high quality of life. And, if you see any changes in your vision, make sure to make an appointment with your ophthalmologist as soon as possible—early detection can make a world of difference.
Sources:
- Johns Hopkins Medicine. Age-Related Macular Degeneration.
- American Academy of Ophthalmology. Geographic Atrophy.
- Colijn JM, Liefers B, Joachim N, et al. Enlargement of geographic atrophy from first diagnosis to end of life. JAMA Ophthalmol. 2021;139(7):743-750.
- American Journal of Managed Care. FDA Approves First Treatment for Geographic Atrophy.
- Parfitt A, Boxell E, Amoaku WM, Bradley C. Patient-reported reasons for delay in diagnosis of age-related macular degeneration: a national survey. BMJ Open Ophthalmol. 2019;4(1):e000276.
- American Optometric Association. Low Vision and Vision Rehabilitation.
- Fonteh CN, Mathias MT, Mandava N, et al. Mental health and visual acuity in patients with age-related macular degeneration. BMC Ophthalmol. 2022;22:391.
- Colenbrander A. Vision rehabilitation is part of amd care. Vision (Basel). 2018;2(1):4.
- Caswell D, Caswell W, Carlton J. Seeing beyond anatomy: quality of life with geographic atrophy. Ophthalmol Ther. 2021;10(3):367-382.
- Johns Hopkins Medicine. Causes and Symptoms of Caregiver Burnout.
