5 Signs and Symptoms of Geographic Atrophy

You may not notice any symptoms in the early stages of this vision-threatening eye disease.

You use your eyes just about every waking moment, so you might assume that if something were wrong with your vision, you’d notice. And yet, that isn’t always the case. Many eye diseases, such as geographic atrophy (GA), can progress so stealthily — and with so few symptoms — that it can take some time before you’re aware anything is wrong.

GA is an advanced form of dry age-related macular degeneration (AMD), which is a leading cause of vision loss among older people.

Geographic atrophy progressively damages your macula, an area at the center of your retina (the light-sensitive tissue in the back of the eye that allows you to see). When the macula becomes damaged, your central vision starts to deteriorate, which interferes with your ability to drive, read, and see faces.

It’s estimated that 20 million Americans have AMD, and about 20 percent of people with AMD develop GA.

Around one million people in the United States have geographic atrophy, according to a review.

Until 2023, there was no way to treat geographic atrophy, which made it difficult to slow its progression and try to preserve remaining vision. In February 2023, though, the U.S. Food and Drug Administration approved pegcetacoplan (Syfovre), a drug that can be injected directly into the eye to curb how quickly GA progresses, marking a significant change in the management of the disease for some people. Since then, another injection medication, avacincaptad pegol (Izervay) has also been approved.

According to the review, there is also research being done around cell replacement, complement pathway inhibitors, and antioxidative and anti-inflammatory agents, giving people with geographic atrophy some hope for keeping the condition under control.

Because early diagnosis is crucial to managing AMD and reducing your risk of GA, it’s important to know the signs and symptoms to watch out for:

1. Small Distortions in Your Vision

At first, there may be small areas in your vision that appear blurry, says Nora Lad, MD, PhD, an ophthalmologist and retinal specialist with Duke Health in Morrisville, North Carolina. The damage begins at the periphery of your macula and then moves toward the center. So, initially, you may have what Dr. Lad describes as patchy, piece-y, or blurry blind spots.

This symptom itself can be problematic. Because you may keep the center part of your vision and see relatively well, there may be delays in diagnosis, according to the Macular Degeneration Association.

2. Trouble Seeing in Dim Light

Over time, reading or driving at night may become more difficult, says Lad. “There’s a gradual loss of central vision,” she explains. You might have trouble seeing in dim light or need extra light to read, and you may also find that you have difficulty adjusting to darkness.

This can be a particularly tricky symptom to spot, because we naturally tend to need more light to see better (and more time to adjust to lighting changes) as we age, according to the American Optometric Association.

3. Blurred Faces

“As the disease progresses, blind spots enlarge and coalesce closer to the center of the macula … so you may have trouble seeing faces,” says Lad. An estimated 63 percent of people with geographic atrophy reported difficulty recognizing faces, according to a review.

4. Faded Colors

Did that blue sweater fade in the washer recently? Research indicates that certain photoreceptors located in the retina can become damaged in people who have geographic atrophy.
Those photoreceptors are sensitive to red, green, and blue light, according to the American Optometric Association, so colors may look more muted or paler than usual.

5. Wavy Lines

According to the National Eye Institute, straight lines may appear wavy or crooked in late-stage AMD.
If you aren’t sure what you’re seeing, are experiencing this concerning symptom, or have AMD, Prevent Blindness suggests downloading and printing an Amsler grid to test your eyes daily.

The Amsler grid consists of a big grid of boxes with a circle in the middle. To use it, you’ll simply stare at the grid with one eye while covering the other eye. If any lines look wavy, seem blurry, or are missing, talk to your doctor.

Be on the lookout for any changes in your vision, so you can tell your eye doctor sooner rather than later. You should also go in for a comprehensive eye exam on a regular basis.

Although there is no treatment for early dry AMD, intermediate-stage dry AMD can be treated with specific dietary supplements. And late-stage AMD, including geographic atrophy, can now be treated with eye injections.

The Takeaway