GA Therapies: Patient Selection & Challenges in AMD Management – 2026 Update

The introduction of disease-modifying therapies for geographic atrophy (GA) is reshaping clinical practice, bringing both promise and challenges for specialists and patients alike. While these therapies represent a significant step forward in managing this progressive form of age-related macular degeneration, careful patient selection, realistic expectation management, and logistical considerations are crucial for successful implementation. The landscape is further complicated by differing regulatory approvals and ongoing research into optimal treatment strategies.

A New Era in GA Management

For years, management of GA was largely limited to observation and supportive care, such as recommending AREDS2 supplements. In 2023, the FDA approved two complement inhibitor therapies – Syfovre (pegcetacoplan injection, Apellis) and Izervay (avacincaptad pegol intravitreal solution, Astellas). These therapies aim to slow the progression of GA by targeting the complement pathway, a key driver of the disease. However, it’s important to understand that these treatments do not reverse existing damage or restore lost vision; their effect is to potentially slow the rate of progression.

This distinction is critical for patient counseling. The lack of immediate, noticeable improvement, coupled with the necessitate for frequent intravitreal injections, can be discouraging for patients. Specialists are facing increased chair time to discuss treatment options, monitor patients, and manage expectations. The influx of these new treatments also adds to the already substantial workload associated with managing wet age-related macular degeneration (AMD), requiring clinics to adapt and potentially expand their teams.

Navigating Regulatory Differences

The availability of these therapies isn’t uniform globally. While approved in the United States, Syfovre faced rejection by the European Medicines Agency (EMA) in late 2025, citing concerns about the balance of benefits and risks. This decision has left European physicians and patients frustrated, as they are unable to access a treatment option available elsewhere. As Patricia Udaondo, MD, PhD, practicing in Spain, notes, the lack of access hinders the ability to gather real-world data and identify which patients benefit most from these therapies.

The Importance of Patient Selection

Identifying the right candidates for these therapies is paramount. Judy E. Kim, MD, a member of the Healio | OSN Retina/Vitreous Board, emphasizes that patients who are most motivated are often those who have already experienced vision loss in one eye due to GA or have advanced AMD in one eye with GA in the other. This is because these patients are acutely aware of the potential for further vision loss and are more likely to adhere to the treatment regimen.

Some data suggest that patients with early-stage disease and good remaining vision may also benefit, but this requires a willingness to commit to long-term treatment. The decision is ultimately a personal one, as these therapies require repeated injections, multiple visits, and carry potential risks such as infection and inflammation. Careful discussion of these factors is essential.

Understanding Treatment Schedules and Combination Therapies

Currently, Syfovre is approved for both monthly and every-other-month administration, while Izervay is approved only for monthly injections. However, many specialists are adopting an intermediate approach, injecting every 6-8 weeks to reduce the treatment burden on patients. The optimal interval remains an area of ongoing research.

A further complication arises when patients also require treatment for wet AMD. Allen Chiang, MD, suggests that administering anti-VEGF therapy for wet AMD and complement inhibitors for GA on separate days may help to differentiate any potential side effects. However, this approach increases the frequency of clinic visits.

What the Future Holds

Despite the challenges, the introduction of these therapies represents a significant advancement in the field of GA. Ongoing research is focused on developing new treatment approaches, including alternative drug delivery methods, such as subcutaneous injections, and exploring therapies that target different pathways involved in GA progression. The development of software to more accurately track disease progression and assess treatment response is also a priority.

As Baruch D. Kuppermann, MD, PhD, notes, the key to success lies in continuous monitoring, individualized treatment plans, and a commitment to understanding the long-term effects of these therapies. The field is still learning, and ongoing data collection and analysis will be crucial for refining treatment strategies and improving outcomes for patients with geographic atrophy.

For more information, consult with a qualified ophthalmologist or visit the American Academy of Ophthalmology website.