Geographic Atrophy: An Expert’s Perspective

By Sharon Solomon, MD, arsenic told to Keri Wiginton 

Geographic atrophy (GA) is an precocious barren shape of age-related macular degeneration (AMD). Up to 20% of folks pinch AMD whitethorn get it. While we spot GA crossed each populations and races, it’s much communal successful older folks who person a family history of AMD and those of European descent. 

GA tends to advancement incredibly slowly, but it tin beryllium devastating for nan subset of group who get it. However, nan FDA precocious approved nan first supplier for GA. And I expect we’ll spot much options down nan line. 

I want group to cognize that it’s uncommon to spell wholly unsighted from this condition. GA doesn’t impact your broadside vision, and you’ll beryllium capable to look astir successful nan morning, get dressed, and return attraction of yourself. 

Again, I want to reassure folks, moreover those pinch late-stage disease, that it’s imaginable to support your independency pinch GA. Other oculus diseases whitethorn make it difficult to show nan quality betwixt nighttime and day. This isn’t that. 

What Is Geographic Atrophy?

People who person GA suffer light-sensitive cells and insubstantial successful nan retina. This thinning, aliases atrophy, tends to hap very adjacent to nan halfway of nan backmost portion of your oculus aliases macula. You usage this area to read, drive, and attraction straight connected immoderate good detail. 

For example, erstwhile you look astatine nan connection “the,” you usage nan cardinal portion of your macula called nan fovea to attraction connected nan “h” successful nan center. Often, surface science atrophy occurs successful this area. 

People often show maine they can’t spot letters erstwhile they effort to read. As nan atrophy grows, full words whitethorn disappear. And successful terrible cases, they can’t publication thing connected nan page because everything they attraction connected is successful this blank area. We telephone that missing portion of nan ocular section a scotoma. 

If you person a loved 1 pinch GA, it tin beryllium difficult to grasp what they’re going through. Relatives often show maine they don’t understand why their loved 1 says they person imagination trouble. They cognize their mom tin spot because they’ve watched her prime up a pen, get dressed, aliases put connected makeup.

I effort to explicate that nan illness doesn’t thin to advancement truthful overmuch that it affects insubstantial extracurricular nan macula. Your loved 1 whitethorn navigate nan world conscionable good pinch nan peripheral aliases broadside imagination that remains intact. 

For example, I’ve treated group pinch GA who tin locomotion into nan exam room and spot themselves -- truthful we cognize they tin spot -- but erstwhile we inquire them to publication letters connected a chart, they ask, "What chart?"

The full floor plan goes missing because that’s really ample nan blank spot successful nan cardinal imagination has become. 

What Are Some Symptoms of Geographic Atrophy?

Geographic atrophy affects everyone differently, and immoderate group don’t announcement they person it. In nan early stages, you whitethorn deliberation you person problem reference because you request a caller medicine for your glasses. 

But you whitethorn person problem recognizing faces. Some folks pinch GA show maine that erstwhile they look straight astatine people, they can’t spot their eyes aliases nose. But they tin usage their broadside imagination to spot nan apical of someone’s caput and their shoulders. 

GA tin impact really good personification sees contrast, and you whitethorn not beryllium capable to show nan quality betwixt colors. That’s because your cones (the cells that power color) are successful nan macula. Your achromatic and achromatic cells are successful nan peripheral retina. 

I’ve ne'er had personification show maine they only spot successful achromatic and white. Someone pinch GA tin astir apt guidelines successful a pasture and cognize that a barn is red. But they’ll show maine they’re little primed to prime up colors erstwhile they’re reading. And they whitethorn not beryllium capable to show nan quality betwixt bluish aliases greenish print, for example. 

At a definite point, group pinch GA whitethorn person truthful galore unsighted spots it’s unsafe for them to drive. 

But erstwhile group don’t want to springiness up their keys, I explicate that if you’ve mislaid immoderate aliases each of your cardinal vision, you whitethorn not announcement aliases beryllium capable to respond accelerated capable to debar an animal aliases kid who darts retired into nan road. That tends to deed location pinch people. 

Strange Sights

People pinch GA sometimes get Charles Bonnet syndrome. What happens is group whitethorn spot afloat formed images that aren’t there, but they won’t person auditory hallucinations astatine nan aforesaid time. They thin to spot things that are acquainted to them. Like dreams, these visions whitethorn beryllium mean aliases creative. But it’s usually based connected immoderate lived experience. 

This ocular arena happens to folks pinch AMD and different diseases that origin imagination loss. I don’t deliberation we cognize precisely what causes it, but nan go-to mentation is that nan encephalon is trying to capable successful missing data.

Understandably, folks who spot things that aren’t location are often acrophobic to speak up. But erstwhile they do get nan courageousness to show maine what’s happening, they picture seeing things for illustration pinkish fences floating astir aliases flowers connected trees successful winter. A dormant loved 1 whitethorn look and disappear. 

As described to me, these ocular hallucinations thin to past seconds aliases minutes. It’s not for illustration your dormant friend aliases family personnel sits pinch you each day. And folks accommodate highly good and are tremendously reassured erstwhile I explicate what’s happening and that it’s not a psychological aliases psychiatric issue.

That said, it’s important to show your expert if you spot things that aren’t there. If you person a loved 1 pinch GA, inquire if this happens to them. Other things tin origin ocular hallucinations, including medicine aliases different wellness problems.

Advice for Caregivers 

Sometimes family members aren’t that sympathetic, and they get disappointment because they don’t understand why their loved 1 pinch GA struggles to spot only definite things. 

I effort to explicate really GA affects someone’s good focus. So possibly personification tin driblet their pen and prime it up because nan pen is big, and they tin spot it pinch their peripheral vision. But those aforesaid group tin still person problem reading, driving, aliases paying their bills. 

Sometimes I’ll person a family personnel travel and look done nan microscope pinch maine for illustration I would pinch a aesculapian student. I’ll constituent retired colour differences that show wherever pieces of nan retina are missing yet immoderate areas are intact. This tin beryllium eye-opening.

Future Treatment for Geographic Atrophy

In nan past, location was a large attraction connected really to negociate bedewed AMD. But you tin decidedly spot that supplier companies and others are pouring investigation dollars into ways to dainty GA. 

And it’s encouraging that these caller narcotics person been FDA-approved. It’s bully to cognize that they’re making medications that target nan biologic pathways that origin nan progression of GA. 

I show group that nan outlook for GA curen is promising. Just for illustration erstwhile our first therapy came retired for bedewed AMD, and 5 years later we sewage different therapy that blew nan aged 1 retired of nan water, I fishy that’s what we’re going to commencement to spot here.  

Steps to Take After a GA Diagnosis

Without a cure, I ever spell complete manner changes that whitethorn thief sphere nan show personification has left. And since we cognize that baccy usage aliases vulnerability to secondhand baccy fume tin raise your likelihood of GA, I propose group discontinue smoking aliases walk little clip astir smokers. 

The 2nd point I’ll do is make judge personification pinch GA is connected an AREDS supplement. These are a circumstantial operation of high-dose vitamins and minerals that whitethorn slow nan progression of intermediate barren AMD to late-stage disease. 

Unfortunately, GA whitethorn advancement to imagination loss, which makes mundane life harder. But group amaze maine each time pinch their resilience and expertise to adapt. 

The bully news is I tin mention folks to low-vision services erstwhile they request it. Visual immunodeficiency for illustration stronger glasses aliases magnifiers, for example, tin thief group to publication amended and usability usually for a batch longer. 

Photo Credit: E+ / Getty Images

SOURCE: 

Sharon Solomon, MD, Katharine M. Graham professor of ophthalmology, Wilmer Eye Institute; professor of ophthalmology, Johns Hopkins University School of Medicine.