Hiding in plain sight: How evolving research to better understand geographic atrophy could improve patient outcomes


The progression of geographic atrophy is not well understood and its impact is frequently underestimated; two observational studies aim to change these misperceptions.

Geographic atrophy, an advanced form of age-related macular degeneration (AMD), is a progressive, irreversible disease of the eye which accounts for approximately 26% of cases of legal blindness in the UK alone. Over 5 million people worldwide live with this disease, but limited understanding of how this devastating disease progresses is leaving some patients behind, as there is no clear treatment pathway.

Two ongoing observational studies, Proxima A and B, aim to improve our knowledge of geographic atrophy and to deliver improved care for patients. In each study patients will be followed for up to 5 years to collect natural history data on geographic atrophy progression and its relationship to loss of visual function. Researchers also intend to generate new information on the relationship between genetics and geographic atrophy progression.

Nancy Holkamp
Nancy Holkamp

We spoke to lead investigator Dr Nancy Holekamp to learn more about the impact of these studies on the future of geographic atrophy management. Dr Holekamp is Professor of Clinical Ophthalmology and Visual Sciences at the Washington University School of Medicine, and Director of Retina Services at the Pepose Vision Institute in St. Louis, Missouri.

Roche: Why did you choose to focus your research on geographic atrophy?

Dr Holekamp: Geographic atrophy is one of the last remaining retinal diseases for which we have no treatment. We have never truly studied the disease on its own, but rather in the context of advanced age-related macular degeneration (AMD). Geographic atrophy remains a significant unmet medical need and preventing the progression of geographic atrophy is the main objective of this era. Through Proxima A and B, we can put geographic atrophy front and centre as a priority in ophthalmology.

How will knowing more about the relationship between genetics and geographic atrophy progression help patients?

A lot of what we have to learn is how genotype determines phenotype. Genetic diagnosis of the disease will show if there is a link with the natural occurrence of biomarkers, such as Complement Factor I. Identifying a link between a certain biomarker and geographic atrophy may give us insights into how genetics affects disease progression.

What insights do you hope the Proxima studies will reveal about geographic atrophy?

The Proxima studies are designed to answer important questions around geographic atrophy and address gaps in our knowledge.

We are asking questions to help us identify more optimal treatment pathways, such as:

  • How fast does geographic atrophy progress, and is it the same for everyone?
  • How devastating is geographic atrophy for patients – is there an impact even if they have reasonable visual acuity?

The answers to these questions will show how each geographic atrophy patient has their own natural history as the disease marches toward legal blindness.

How progression of vision loss in GA looks like
How people with geographic atrophy may experience vision loss as the condition progresses

In your opinion, what should be done now to improve geographic atrophy management?

It’s an exciting time to be a retina specialist. Geographic atrophy used to be about as interesting as your big toenail – we didn’t know much about it. Now we're on the verge of a better understanding.

There is still confusion around the differences between geographic atrophy and neovascular AMD. However, they are different diseases and we can’t describe them with the same language or diagnose them with the same tests. Educating doctors and the public about geographic atrophy is needed so the right patients can be actively directed towards better outcomes.

Funding for these studies was provided by Hoffmann La Roche

Tags: Science, Patients, Ophthalmology, Geographic Atrophy