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While lesion growth in advanced dry AMD may appear to proceed slowly, disease progression is often constant and irreversible.15, 17

Progression can be highly variable, it typically takes several years from the onset of advanced dry AMD to cause consistent deficits in vision.26

This is because the fovea, which is responsible for
central vison and visual acuity, may be spared until
advanced dry AMD is very advanced.26

However even before the fovea is affected by advanced
dry AMD, lesion growth is already affecting functional vision.10, 15

98%

of patients with wet
AMD progressed to
advanced dry AMD over
an average of 7.3 years
of follow-up.12

Advanced Dry AMD

Geographic Atrophy

Advanced dry AMD or Geographic
Atrophy is a term used to describe the
advanced form of dry age-related macular degeneration (AMD), is a progressive and
irreversible disease affecting the macula,
the central part of the retina.1, 2

5 million

Currently advanced dry AMD affects more than
5 million people worldwide. This number is expected to increase to more than 10 million by 2040.3

4×

From age 50, prevalence quadruples every
10 years.4

20%

Advanced dry AMD
accounts for up to 20% of all legal
blindness attributed
to AMD.1, 5

Advanced dry AMD is a chronic progressive degeneration6 of the macula, which is a central part of the retina that allows the eye to see accurate details for daily activities.7, 8

The retina contains millions of light-sensitive cells
(rods and cones) that receive and organize visual information.7

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The fovea at the center of the
macula is a small pit that contains the largest concentration of cone cells thus provides greatest visual acuity.9

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Drusen are small yellow deposits of fatty proteins (lipids) that
accumulate under the retina. They can be used to grade the stage and severity of AMD.10

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Advanced dry AMD and wet age-related
macular degeneration (wAMD) are different
manifestations of advanced AMD.11

An eye with advanced dry AMD can also
naturally develop wet AMD; and vice versa.11

Causes

Dry and Wet AMD

Signs and symptoms of advanced dry AMD may include:16

Risk factors associated with advanced dry AMD16

In people with AMD, the photoreceptors in the macula, the part of the retina responsible for sharp vision and color recognition, deteriorate.14

Advanced dry AMD is characterized by progressive and irreversible
loss of the retinal pigment epithelium, photoreceptors, and underlying choriocapillaris, all of which are key components of the macula.2, 15

Healthy photoreceptors

Deteriorated photoreceptors

Hazy or blurred vision.

Straight lines may appear crooked.

An inability to see details closely, as well as difficulty identifying objects from a distance.

A small, but growing, blind spot in the centre of vision.

Inability to identify and distinguish colours.

The most predictive and central feature of developing advanced dry AMD is larger (>125 μm) or merging drusen as over 95% of patients with these features develop advanced dry AMD.15

Advanced dry AMD can be diagnosed and monitored by an ophthalmologist,
retinal specialist or optometrist.20

Retinal imaging techniques are used to identify, diagnose and monitor all stages of AMD, including advanced dry AMD. When diagnosing and monitoring AMD, your eye doctor will look for the following features in the retina by applying ophthalmoscopy or on fundus photo.21, 22 This may include:

Decorated with drusen.

A sharply demarcated area in the macular region with an atrophic retina, lacking pigmentation.

Visible underlying choroidal blood vessels.

Fundus autofluorescense angiography imaging is currently a standard imaging technology to visualize the retinal pigment epithelium (RPE) in advanced dry AMD.23

Optical coherence tomography (OCT): The atrophy of the retinal layers can be clearly seen with this non-invasive imaging technique.24, 25

While lesion growth in advanced dry AMD may appear to proceed slowly,
disease progression is constant and irreversible.15, 17–19

Disease progression

Diagnosis

Ways to diagnose

To date, there are no approved therapies to reduce the rate of advanced dry AMD

progression, although several potential therapies are under investigation.16

Treatment of advanced dry AMD

How to best manage advanced dry AMD16

Overview of treatment strategies under investigation26

Modulating the visual cycle to reduce the accumulation of toxic byproducts

Reducing or inhibiting drusen formation

Complement inhibition to regulate an overactive complement system

Improving blood flow in the choroid

Reducing or eliminating oxidative stress

Reducing or eliminating inflammation

Replacing, repairing, or regenerating lost RPE cells and photoreceptors

Cell therapy

Regular eye examinations

Progression of advanced dry AMD may be managed through regular eye
examinations and early detection of the retinal changes.

Visual rehabilitation

In addition to regular eye examinations, the disease can also be managed through visual rehabilitation with the use of magnifiers and low vision aids.

Lifestyle modification16, 27

Some simple approaches that can help prevent or slow the
progression advanced dry AMD include:

Stop smoking
Exercising to reduce BMI
Eating foods low in cholesterol
Intake of antioxidants & vitamins such as vitamin C,
vitamin E, beta-carotene and zinc

References

Gehrs KM, et al. Ann Med. 2006;38(7):450-471.
Fleckenstein M, et al. Ophthalmology. 2018;125:369-390.
Wong WL, et al. Lancet Glob Health. 2014;2:e106-116.
Rudnicka AR, et al. Ophthalmology. 2012;119:571-580.
Biarnés M, et al. Optom Vis Sci. 2011;88(7):881-889. 11
Fleckenstein, M. et al. The progression of geographic atrophy secondary to age-related macular degeneration.
Ophthalmology 125, 369–390 (2018).
Bear, M., Connors, B. & Paradiso, M. Neuroscience: Exploring the Brain (Third Edition). Library (Lond). (2006) doi:10.1007/BF02234670.
Mitchell, P., Liew, G., Gopinath, B. & Wong, T. Y. Age-related macular degeneration.
www.thelancet.com vol. 392 www.thelancet.com (2018).
Remington, L. A. Aqueous and Vitreous Humors. in Clinical Anatomy and Physiology of the Visual System 109–122 (Elsevier Health Sciences, 2012). doi:10.1016/b978-1-4377-1926-0.10006-2.
Klein, R. et al. The Wisconsin Age-related Maculopathy Grading System. Ophthalmology 98, 1128–1134 (1991).
Age-Related Macular Degeneration: Facts & Figures. Bright Focus Foundation. Accessed Apr. 29, 2021.
https://www.brightfocus.org/macular/article/age-related-macular-facts-figures
Rofagha S, et al, SEVEN-UP Study Group. Ophthalmology. 2013;120(11):2292-2299.
Ferris FL 3rd, et al. Ophthalmology. 2013;120(4):844-851.
Young, R. W. Pathophysiology of age-related macular degeneration. Surv. Ophthalmol. 31, (1987).
Boyer, D. S., Schmidt-Erfurth, U., Van Lookeren Campagne, M., Henry, E. C. & Brittain, C. The pathophysiology of geographic atrophy secondary to age-related macular degeneration and the complement pathway as a therapeutic target. Retina 37, 819–835 (2017).
Geographic Atrophy. Eye See You. Accessed Apr. 29, 2021. https://eyeseeyou.care/en/geographic-atrophy/
Sunness JS, et al. Ophthalmology. 2007;114(2):271-277.
Holz FG, et al. Ophthalmology. 2014;121(5):1079-1091.
Lindblad AS, et al. Arch Ophthalmol. 2009;127(9):1168-1174.
Lakshminarayanan, V. Visual acuity. In: Chen J, Cranton W, Fihn M eds. Handbook of Visual Display Technology.
Vol. 1. Springer-Verlag Berlin Heidelberg; 2012:93-99. 3. Chandramohan A, Stinnett SS, Petrowski JT. Visual
function measures in early and intermediate age-related macular degeneration. Retina. 2016;36(5):1021-31.
What is the difference between direct and indirect ophthalmoscopy? American Academy of Ophthalmology.
Accessed Apr. 29, 2021.
https://www.aao.org/eye-health/ask-ophthalmologist-q/what-is-difference-between-direct-indirect-ophthal
Geographic Atrophy. EyeWiki. Accessed Apr. 29, 2021. https://eyewiki.aao.org/Geographic_Atrophy
Townsend WD. Scleral depression. Optom Clin. 1992; 2(3);127-44 (1992).
Ferguson LR, Grover S, Dominguez II JM, Balaiya S, Chalam KV. Retinal thickness measurement obtained with spectral domain optical coherence tomography assisted optical biopsy accurately correlates with ex vivo histology. PLoS ONE. 2014;9(10), e111203.
What Is Optical Coherence Tomography? American Academy of Ophthalmology. Accessed Apr. 29, 2021.
https://www.aao.org/eye-health/treatments/what-is-optical-coherence-tomography.
Buschini, E. et al. Recent developments in the management of dry age-related macular degeneration.
Clinical Ophthalmology vol. 9 563–574 (2015).
Bishop, P., Fekrat, S. & Chakravarthy, U. BMJ Best Practice: Age-related macular degeneration. Br. Med. J. (2018) doi:10.1016/S0140-6736(18)31550-2.

For more information visit dryAMD.eu

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Advanced dry age-related macular
degeneration (AMD) / Geographic Atrophy (GA)

Non-modifiable
risk factors

Age:

There is an increased chance of
being diagnosed with advanced dry AMD the older people become.

Genetics:

People with a family history are at a higher risk of developing the condition.

Ethnicity:

The prevalence of advanced dry AMD is highest among older people of Caucasian descent.

Modifiable environmental
risk factors

Smoking tobacco and cigarettes increases the likelihood of
developing advanced dry AMD.

Body Mass Index (BMI):

Individuals with a BMI of 30 and over are more susceptible to
developing advanced dry AMD.

Fatty diets:

Consumption of foods high in
cholesterol and fat can increase a person’s glycemic index which causes disposition of adipose
tissue in the blood vessels of the retina.

Usage of medications:

Certain medications have been linked with an increased risk
of developing AMD. If you are
taking any medication for other conditions you should discuss this with your healthcare professional.