By Rukhsana G. Mirza, MD, as told to Rachel Reiff Ellis
To understand how far we’ve come with geographic atrophy (GA), it’s important to start with the basics of the disease. Age-related macular degeneration (AMD) is the leading cause of vision impairment in older adults. There are two types: wet AMD, which is more aggressive, and dry AMD, which in its late stages can lead to GA.
The treatment for wet AMD has been revolutionized during my career. When I was a resident, there was no wet AMD treatment that could improve your vision, only a thermal laser which burned areas of abnormal blood vessels in your eye.
But then we developed photodynamic therapy to address abnormal blood vessels. Not long after, anti-VEGF treatments. Suddenly, I wasn’t seeing people with large areas of scarring anymore. The injections changed that.
These developments with wet AMD are why I'm excited about the development of a new approach to dry AMD. Because we've seen how rapidly, and with such promise, innovation can come to those we treat.
New FDA-Approved Treatments for Dry AMD
As of 2023 there are now two FDA-approved medications for slowing down the progression of GA: avacincaptad pegol (Izervay) and pegcetacoplan (Syfovre). We still consider these very new and not for everyone. But they have promise for some.
These medicines work by targeting part of your immune system called the complement cascade. That’s a group of proteins in your blood that help your immune system. They’re normally inactive but can be switched on in a certain order to help kill germs or boost your immune response. When the medications disrupt part of the cascade, it dampens your immune response so there’s less damage to your retina.
You get the medications by an injection into your eye, either monthly or every other month. It’s important to know these medications don’t bring back retinal tissue you’ve already lost. They help slow the rate of further loss. But even though that doesn’t improve your vision, it’s still an exciting advancement. Because prior to 2023, we didn't have any interventions at all.
These drugs are part of a diverse group of GA treatments researchers are studying. They’re exploring oral options, eye injections, and other procedures. And they're targeting different metabolic pathways, working on improving cell survival, and even exploring cell replacement.
The FDA also recently approved some other newer non-drug-related treatments, such as photobiomodulation — a noninvasive technique that uses light to stimulate or inhibit cellular function — for intermediate AMD, as well as surgically implanted telescopes.
Future Hopes for Advancement
We’re still evaluating the risk-benefit ratio for these new treatments. But we know we’re approaching the next frontier for dry AMD treatment. And there’s excitement around that.
AMD takes your central sight, which is your most sensitive vision. But it doesn't take all your vision. You still have a lot of retina that's intact, and harnessing that retina is important. Our goals right now are to make the areas you don't see as small as possible so you can utilize more of your retina.
I'm hopeful that in the near future we can intervene before GA begins, rather than slowing down the progression. If we can slow it down much earlier in the process, we can prevent loss of vision.
Another innovation that's coming out is imaging we’re seeing in the office called optical coherence tomography or OCTs. There are new devices that are home OCT monitors. We're going to learn even more about the people we treat, as those are utilized in the future. When people stay connected and monitor their vision at home, they're a partner in preserving their own sight.
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SOURCE:
Rukhsana G. Mirza, MD, Ryan-Pusateri Professor of Ophthalmology and Professor of Medical Education, Medical Retina specialist, Northwestern Medicine.
