Current Treatments and Future Perspectives in Geographic Atrophy

Abstract

Geographic atrophy (GA) secondary to age-related macular degeneration (AMD) is a progressive retinal degenerative disease and a major cause of irreversible vision loss in older individuals. No curative therapy is currently approved. This narrative review summarizes current and emerging therapeutic strategies for GA. The complement system has emerged as a key therapeutic target, leading to the first approved pharmacological interventions for GA. Complement inhibitors, namely pegcetacoplan (C3 inhibitor) and avacincaptad pegol (C5 inhibitor), approved by the FDA in 2023, have demonstrated consistent reductions in GA lesion growth across phase 2 and phase 3 clinical trials. Although these therapies provide meaningful structural preservation, functional benefits remain modest, and treatment has been associated with an increased risk of conversion to neovascular AMD, highlighting the need for careful patient selection and monitoring. Nutritional supplementation, particularly antioxidant formulations and lutein/zeaxanthin, has shown limited but measurable benefits in slowing disease progression, while photobiomodulation and emerging gene and cell-based therapies appear promising strategies for retinal preservation and regeneration. Despite recent advances, GA continues to be a debilitating condition with a significant impact on patients’ quality of life. Current therapies offer partial benefits and do not halt or reverse retinal degeneration. Ongoing research aimed at optimizing treatment timing, combination strategies, and regenerative approaches is essential to improve long-term visual outcomes and address the substantial unmet needs associated with GA.