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Retinal Physician

Article

Visual Function Benefit of Treatments for Geographic Atrophy

Are reported visual function results in GA trials evidence of absence, or simply an absence of evidence?

Zhichao Wu, BAppSc (Optom), PhDRobyn Guymer, AM, MBBS, PhD, FRANZCO, FAHMS
Retinal Physician February 1, 2026

Clinical Report: Visual Function Benefit of Treatments for Geographic Atrophy

Overview

Revise to better connect GA growth rate reduction with visual function implications.

Background

Geographic atrophy, a consequence of age-related macular degeneration, leads to progressive vision loss, significantly impacting patients' quality of life. The recent approval of therapies aimed at slowing GA progression represents a potential shift in treatment paradigms. However, the lack of significant improvements in visual function endpoints in pivotal trials has generated concern among clinicians regarding the effectiveness of these treatments.

Data Highlights

No significant treatment effects were observed for prespecified visual function endpoints in recent trials.

Key Findings

  • Pivotal trials of pegcetacoplan and avacincaptad pegol showed approximately 15% reduction in GA growth rates over 12 months.
  • No significant treatment effects were observed for visual acuity, reading speed, or visual sensitivity endpoints.
  • Measurement variability for visual acuity and reading speed is 4 to 7 times higher than for structural measurements of GA extent.
  • Conventional microperimetry demonstrated weak correlations with GA extent, limiting its effectiveness as an outcome measure.
  • Clinical trials are underpowered to detect meaningful changes in visual function due to reliance on global functional measures.

Clinical Implications

Clinicians should be cautious in interpreting the efficacy of GA treatments based solely on visual function outcomes. Emphasis on structural measures and early intervention may enhance patient management strategies.

Conclusion

The findings underscore the need for more sensitive functional assessments in GA trials to better capture treatment benefits, as current visual function measures may not adequately reflect the impact of therapies.

References

  1. Retinal Physician, Treatment of Geographic Atrophy by Anatomic Location, 2023 -- Complement inhibitors could slow progression in lesions with and without subfoveal involvement.
  2. Ophthalmology Management, Case Study: Early Treatment of Geographic Atrophy, 2026 -- Identifying and treating GA patients early is the most impactful decision.
  3. Retinal Physician, CONTROVERSIES IN CARE: Treatment of Geographic Atrophy, 2023 -- Retina specialists weigh the benefits and risks.
  4. Oregon Health & Science University, Age-Related Macular Degeneration Preferred Practice Pattern -- Clinical guidelines recognize complement inhibition as a standard disease-modifying option.
  5. PubMed, Avacincaptad Pegol for Geographic Atrophy Secondary to Age-Related Macular Degeneration: Two-Year Efficacy and Safety Results from the GATHER2 Phase 3 Trial -- Landmark trials consistently show anatomical benefit.
  6. retinal physician — Managing Geographic Atrophy and Intravitreal Injections
  7. Age-Related Macular Degeneration Preferred Practice Pattern® - Oregon Health & Science University
  8. Avacincaptad Pegol for Geographic Atrophy Secondary to Age-Related Macular Degeneration: Two-Year Efficacy and Safety Results from the GATHER2 Phase 3 Trial - PubMed