New Decision Tool Could Guide Geographic Atrophy Treatment

Though expected lifespan comes up routinely in glaucoma care, this type of counseling rarely factors into geographic atrophy patient discussions, even though management approaches for both conditions share the goal of preserving vision for the duration of the patient’s life, and studies show links between mortality and total GA area. The Atrophy Advisor tool (shown) combines a lifespan algorithm and an algorithm to predict time it will take for GA to reach the fovea based on the measured distance of the closest edge of GA to the center of the fovea. Photo: atrophyadvisor.com. Click image to enlarge. End-stage dry age-related macular degeneration affects about 2% of individuals over the age of 75 in the United States. Unlike its exudative counterpart, geographic atrophy (GA) causes gradual but irreversible vision loss. Complement inhibitors such as pegcetacoplan and avacincaptad pegol can slow disease progression, but though these drugs limit lesion growth, they don’t affect visual acuity deterioration. Furthermore, they’re accompanied by typical intravitreal injection risks like treatment burden, intraocular inflammation, endophthalmitis and high cost.  When is it worth it to use complement inhibition and when is the burden of injections just too great? To help clinicians answer this question, Wake Forest University researchers developed a decision tool called Atrophy Advisor that considers GA progression and a patient’s estimated lifespan. Their proof-of-concept study published in American Journal of Ophthalmology showed that this tool can guide decisions and improve treatment personalization. The tool is available at https://atrophyadvisor.com.The researchers gathered patient demographics, comorbidities and corrected visual acuities from patient records spanning 2013 to 2025. They estimated lifespan using University of Connecticut and Social Security Administration algorithms and compared these to observed outcomes. Using fundus images taken from 50 dry AMD patients, the researchers measured the distance from the fovea to the nearest GA lesion edge. While most studies use GA lesion area expansion as the primary outcome for progression, the authors note that studies have shown this doesn’t reflect the true functional decline associated with foveal involvement.The median patient age was 78. Baseline median GA-to-fovea distance was 792µm, which declined to 395µm at the last follow-up. Median lesion progression was 122µm/year and demonstrated a direct relationship between initial distance and progression rate.The lifespan calculators produced median estimates of 11.9 and 11 years for this patient group. The mean difference of 1.2 years between the two algorithms resulted in different treatment guidance in 4% of cases. The researchers stated in their paper that “this highlights the need for more precise ophthalmology-specific lifespan models that incorporate systemic risk factors (e.g., hypertension, BMI, smoking) and genetic profiles.” They also advocated for quality-adjusted life expectancy to better evaluate the burden of injections against the benefit of vision preservation at various life stages.The authors concluded that Atrophy Advisor provides a framework to assist clinicians when considering the benefits and risks of complement inhibition. “Possible next steps might involve validating GA proximity metrics in larger, prospective cohorts with standardized imaging protocols, incorporating machine-learning approaches to integrate hyperreflective foci, genetic risk and focality data, and comparing nearest GA edge-based progression model against area-based methods in clinical trials.” Click here for the journal source. Kerwin AF, Perlman EM, Browning DJ. Atrophy Advisor: a clinical tool for dry macular degeneration with geographic atrophy. Am J Ophthalmol 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.