Do you sometimes feel like your vision is gradually decreasing, especially when you look straight ahead, and the center of your vision is not clear, like a dark spot? Do you find it difficult to read a book or a newspaper, or to see things in the dark? So, today we are going to talk about Geographic Atrophy, an eye condition that can occur in some people with age. Don't worry, it is very important to be aware of this.
What is Geographic Atrophy?
Simply put, Geographic Atrophy is the medical name for the most severe, final stage of dry age-related macular degeneration (AMD), a disease that affects the eyes as we age. You may have heard of macular degeneration. This is when the macula , a very important part of the retina inside our eyes, is damaged.
Think about it, the things that you see clearly when you look straight ahead, like the letters when you read a book, or the face when you look at someone, are all things that the macula helps us see clearly. So, when Geographic Atrophy occurs, it is the central vision that is most affected. However, peripheral vision, or things that are seen from the sides, can still be seen.
This condition often affects both eyes (bilaterally). A person with geographic atrophy may experience a dark spot (scotoma) in the center of the eye when looking straight ahead, and visual acuity may be reduced.
How common is Geographic Atrophy?
It affects more than 8 million people worldwide. Geographic Atrophy is a condition that affects about 20% of people with age-related macular degeneration (AMD). So, it's not that uncommon.
What are the symptoms of Geographic Atrophy?
In this situation, you may experience symptoms such as:
- Loss of visual acuity : To be precise, things become less clear and sharp.
- Difficulty reading, driving, and doing manual work : It can be difficult to do any task that requires straight vision. Things like reading small print in a newspaper, watching television, or threading a needle can be difficult.
- A dark spot, or blind spot, in your central vision: Only the area you look at appears black, like a blank space.
- Difficulty seeing in low light : In the evening, things become less visible in low-light areas.
- Colors becoming dull or appearing less bright : Things that previously looked good in color may now appear a bit dull and washed out.
The important thing is that Geographic Atrophy is a condition that occurs at the end of age-related macular degeneration. Therefore, you may not notice any symptoms in the early stages , or you may not notice much difference if only one eye is affected.
What are the causes of Geographic Atrophy?
As we mentioned earlier, this is the final stage of dry AMD. Researchers still don't know exactly what causes these changes inside the eye to develop into geographic atrophy. However, they think that a process called the complement cascade , which is part of our body's immune system, is involved. This means that some process in our body's defense system may be malfunctioning and contributing to this damage. In addition, genetic factors (i.e., things that are passed down from generation to generation) and environmental factors may also play a role.
The most important thing to remember is that geographic atrophy is not a contagious disease . You cannot spread it to someone else.
Who is at higher risk of developing geographic atrophy?
Although this condition can develop in anyone, some people are at higher risk. These include:
- People aged 60 or over.
- White people (although this is less relevant to Sri Lanka, it's good to know).
- People with light-colored eyes.
- If someone in your family has age-related macular degeneration or other genetic conditions that affect the eyes.
- People who smoke or have smoked in the past.
- People who eat a diet low in fruits and vegetables, especially dark green leafy vegetables, are very important for eye health.
- People who are overexposed to sunlight.
- People with vision of 20/200 or worse (normal vision is considered to be 20/20).
In addition, people with other medical conditions such as:
- Malnutrition
- Obesity
- High blood pressure
- High cholesterol
- Diabetes `(Diabetes Mellitus)`
- Coronary heart disease
What are the complications of Geographic Atrophy?
Unfortunately, vision loss due to geographic atrophy is permanent . Once you lose your straight-ahead vision, it can be difficult to perform daily tasks such as:
- Reading books.
- Driving.
- Recognizing people's faces.
- Doing your usual hobbies, chores, or crafts.
This can make life a little difficult, but there are ways to help you cope.
How is Geographic Atrophy diagnosed?
Your eye specialist will diagnose this condition through an eye exam and other tests. The doctor will also ask you about your symptoms, any other medical conditions you have, and whether anyone in your family has had similar conditions.
What tests are done for this?
To diagnose geographic atrophy, your eye doctor may order tests such as:
- Fundus autofluorescence : This is a method of taking pictures of the retina inside the eye. In this, certain substances in the retina, such as lipofuscin , glow under a special light without the need for any eye drops. This can help identify areas of damage.
- Optical coherence tomography (OCT): This is also a non-invasive method of taking pictures of the retina. It uses reflected light. It takes a cross-section of the retina and can see the extent of the damage.
- Microperimetry : This is a way to test your visual field. This means you can see how far you can see and whether there are any dark spots in your vision.
- Multifocal electroretinography : In this test, light is shone onto your retina and the electrical activity in response is measured.
If these tests sound a little complicated, don't worry. Your doctor will explain everything to you.
What are the treatments for Geographic Atrophy?
The good news is that the U.S. Food and Drug Administration (FDA) recently approved two drugs for the first time to treat geographic atrophy. They are pegcetacoplan (SYOFOVRE™) and avacincaptad pegol (IZERVAY™). These are intraocular injections . These injections can slow the progression of geographic atrophy. Your eye doctor will inject these drugs into your eye once a month or every two months.
In addition, your eye doctor may suggest other ways to manage geographic atrophy, such as:
- Visual rehabilitation : You may need visual aids, such as special glasses or magnifying glasses, to help you perform your daily tasks.
- AREDS2 supplements : These antioxidant supplements were tested in the Age-Related Eye Disease Study. Some doctors use them to treat dry AMD. The original AREDS1 formula included beta-carotene along with these ingredients. However, because beta-carotene is associated with an increased risk of lung cancer in smokers , AREDS2 has added lutein , zeaxanthin, vitamin E , zinc oxide , and cupric oxide.
- Implantable miniature telescope (IMT): This involves surgically removing your eye's natural lens and replacing it with this tiny telescope. This device magnifies objects in direct vision and focuses them on other areas of the retina that are still functioning well.
Are there any side effects of the treatment?
Because the new vaccines Pegcetacoplan and Avacincaptad pegol are still very new, experts are still studying their effectiveness and risks. Currently, the following side effects are known to occur:
- Eye pain.
- A bleeding in the white of the eye (Subconjunctival hemorrhage).
- The appearance of floaters in the fluid inside the eye (vitreous humor).
- Neovascularization of the eye.
It is important to talk to your doctor about this and choose the treatment that is best for you.
Can Geographic Atrophy be prevented?
To be honest, there is no way to completely prevent geographic atrophy, as the age-related macular degeneration that causes it cannot be prevented.
However, you can try to reduce your risk of this. That means paying attention to the modifiable risk factors that we can change. We can't change things like age and race. However, you can help reduce your risk by doing these things:
- Not smoking. If you smoke, try to quit.
- Good control of chronic diseases such as diabetes, high blood pressure, obesity, and high cholesterol.
- Wear sunglasses with yellow lenses to protect your eyes when going out in the sun.
- Wear appropriate safety glasses at work, while playing sports, or engaging in hobbies.
- You should follow a healthy diet and exercise plan. Especially include green vegetables, herbs, and fruits in your diet.
What happens if I have Geographic Atrophy?
In general, the outlook for people with geographic atrophy is not very good in terms of vision. However, the disease affects each person differently. New treatments have brought some hope.
The most important thing is that Geographic Atrophy is not a fatal disease and it will not affect your lifespan.
When should I see a doctor?
Your eye doctor will tell you how often you should have your eyes checked. Tell your doctor right away if you notice any changes in your eyes or vision.
If you experience sudden vision loss or severe eye pain, it is essential to seek medical advice immediately.
What questions should I ask the doctor?
When you go to see the doctor, you can ask questions like:
- Do I have geographic atrophy or another eye disease?
- What tests do I need to do?
- Am I eligible for new medications to treat geographic atrophy?
- How often should I have my eyes checked?
- Can I participate in a clinical trial?
- What changes in my eyes should I watch out for?
- Can you help me find supportive services that can help me?
Finally, things to remember
It's great that there are new treatments for geographic atrophy and that research is continuing. However, it's normal to feel scared when you learn that you have a condition that could permanently affect your vision.
Don't worry. Your eye doctor will tell you more about this condition, what you can expect, and the best treatments to help you manage it. It's important to follow your doctor's instructions and have regular eye exams. Also, the support of your family will be a great help during this time.
Geographic Atrophy, Age-Related Macular Degeneration, AMD, Macula, Eye Health, Vision Loss, Eye Diseases
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