All Eyes on Geographic Atrophy at APVRS 2025: Diagnostic Challenges and Scientific Advances

GA care is shifting from passive monitoring to active management, powered by multimodal imaging and new science

At the 18th Congress of the Asia-Pacific Vitreo-Retina Society (APVRS 2025) lunch session on geographic atrop h y (GA), four speakers made the same point from different angles: the era of passively “watching” dry age-related macular degeneration (AMD) has expired. The clinician’s job now is to recognize progression risk earlier, image with intent and counsel patients for a long game that looks nothing like wet AMD.

From the opening QR poll to the final Q&A, the theme stayed consistent: GA is heterogeneous, imaging is the language of care, and complement inhibition has shifted conversations from nothing to offer to who to treat, when and how to manage the fine print.

A burden that grows with time and age

Prof. Gemmy Cheung (Singapore), chair of the session, opened with a simple reframing: GA sits alongside wet AMD as advanced AMD, and its burden rises as populations age. She cited a headline estimate of roughly five million people affected worldwide, while flagging a practical blind spot in clinic-based figures, especially in parts of Asia where older adults may not present until function drops.

“GA is highly heterogeneous. Our job is to recognize what drives progression and act sooner,” she said. Lesion size, shape, location, focality and pattern steer pace, prognosis and the urgency of follow-up. In other words, “GA” is a label, not a timeline.

With that concept in place, she pointed to complement biology as the scientific thread running through the session’s therapy discussion, then set an expectation for what the hour would prioritize: seeing GA earlier, reading images more confidently and communicating risk in ways patients can actually absorb.

The session wrapped its teaching into a quick audience poll. Participants weighed in on GA imaging norms, how fast patients may lose driving status and which lesion features tend to progress more slowly. The reveal came at the end, a tidy way to show what the hour had changed.

Imaging that steers care

Dr. Kelvin Teo (Singapore) argued that GA care works best when the clinic thinks like an imaging service with a treatment plan attached. One modality rarely tells the whole story, so avoid assumptions.

Start with color fundus photography to anchor case definition using classic reading-center criteria, but do not lean on it for forecasting. Prognosis and follow-up belong to fundus autofluorescence (FAF) and optical coherence tomography (OCT). On FAF, hypoautofluorescence signals retinal pigment epithelium (RPE) loss, while junctional-zone rims and patterns help sort faster from slower progressors. On OCT, use consensus language and call cRORA when you see choroidal hypertransmission with RPE and outer retinal loss.

Dr. Teo urged teams to add top-down tools. En face OCT turns follow-up into clean, comparable area maps when slab settings are standardized across visits. Near-infrared reflectance can settle foveal involvement when FAF is ambiguous or when symptoms do not match a seemingly quiet image. For function, reach for microperimetry at the junctional zone and watch ellipsoid zone integrity, which can reveal photoreceptor compromise before obvious RPE loss.

His line tied scans to symptoms: “GA is a multimodal diagnosis. FAF and OCT tell you what is dying; microperimetry and EZ tell you how that feels to the patient.” In the Q&A, Prof. Gemmy Cheung noted a real friction point. FAF can be hard to acquire well in elderly patients, and “good enough” is not enough for longitudinal decisions.

Impact before symptoms arrive

Dr. Hemal Mehta (Australia) brought the discussion back to impact and timing, noting that GA can start beside the fovea, seem tolerable early on and then move centrally faster than patients expect. Symptoms often lag behind structure, then arrive all at once when the fovea is involved. With real-world cases, he showed how an extrafoveal lesion can grow quickly and then seem to slow once central tissue is gone, a pattern the panel revisited later.

He recommends the use of serial multimodal imaging. It helps patients see what is changing, lets you quantify risk and gives you permission to start long-term treatment conversations before anyone feels “bad enough.” He also broadened the frame beyond letters on a chart. Session slides pointed to early loss of driving in bilateral GA, higher fall risk with visual impairment and real caregiver disruption. The goal is to surface those issues early so planning and support begin while independence is still strong.

For workflow, he pointed to Australian referral guidance that favors structured monitoring. That means regular imaging for intermediate AMD and stepping up when early atrophic change appears. Tool choice is flexible, but scan quality is non-negotiable, especially for en face mapping that supports clean, comparable measurements and straightforward patient explanations.

Complement is here, and the conversation has changed

Prof. Michael Singer (USA) delivered the data-forward therapy update, centering on complement inhibition and what it means for real clinics. His framing was pragmatic: GA therapies do not restore lost retina, but slowing can matter if time is the currency patients spend first.

He reviewed late-stage evidence behind intravitreal complement inhibitors, including pegcetacoplan and avacincaptad pegol, and emphasized that the clinical task is now selection, expectation-setting and monitoring for exudation.

In the Phase III OAKS and DERBY trials of pegcetacoplan, lesion growth reductions at 24 months varied by trial and regimen, with a consistent theme of modest but measurable slowing versus sham.¹ In GATHER2, avacincaptad pegol also demonstrated reduced GA growth at 12 months versus sham, supporting the same directional story across programs.²

Safety, he stressed, is where clinic conversations get real. Trial programs show higher rates of new-onset exudative AMD in treated eyes than sham, meaning clinicians need a plan for surveillance and for layering anti-vascular endothelial growth factor (anti-VEGF) when needed. He also referenced post-approval surveillance discussions, including the ASRS ReST Committee report describing retinal vasculitis cases reported after pegcetacoplan injections, explaining why informed consent and careful follow-up matter in routine practice.³

Prof. Singer’s closing point was the one patients tend to understand best: a “20% slowing” can feel underwhelming in a single year, but cumulative slowing can translate into meaningful functional time if patients stay on therapy and clinics stay ahead of complications.

Preparation is part of the treatment

The Q&A landed on what clinicians feel every week: lesions can surge, then appear to slow, and structure does not always match function. OCT or FAF may look severe while patients keep usable vision through eccentric fixation and a shifting preferred retinal locus.

Access to treatment changes the day-to-day. Clinics see more referrals, longer visits and heavier counseling. Starting therapy at the first appointment is uncommon. GA care benefits from clear goals: an honest risk–benefit talk and time to absorb that this is disease modification…not a “wow” fix. Several speakers even send patients home with reading material, then bring them back ready to decide.

The practical move is consistent and early: diagnose sooner, track growth with serial imaging, begin the conversation before the fovea falls and secure commitment. In GA, preparation is part of the treatment.

Editor’s Note: This content is intended exclusively for healthcare professionals. It is not intended for the general public. Products or therapies discussed may not be registered or approved in all jurisdictions, including Singapore. Reporting for this story took place during the 18th Congress of the Asia-Pacific Vitreo-Retina Society (APVRS 2025) from 12-14 December in Manila, Philippines.

References

Heier JS, Lad EM, Holz FG, et al. Pegcetacoplan for the treatment of geographic atrophy secondary to age-related macular degeneration (OAKS and DERBY): two multicentre, randomised, double-masked, sham-controlled, phase 3 trials. Lancet. 2023;402(10411):1434-48.
Khanani AM, Patel SS, Staurenghi G, et al. Efficacy and safety of avacincaptad pegol in patients with geographic atrophy (GATHER2): 12-month results from a randomised, double-masked, phase 3 trial. Lancet. 2023;402(10411):1449-58.
Witkin AJ, Jaffe GJ, Srivastava SK, et al. Retinal vasculitis after intravitreal pegcetacoplan: report from the ASRS Research and Safety in Therapeutics (ReST) Committee. J Vitreoretin Dis. 2024;8(1):9-20.