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Geographic atrophy
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From Detection to Progression

Imaging plays a critical role in both early diagnosis of GA and in the monitoring of disease progression.

Diagnostic Hallmarks of Dry AMD

Early

Multiple small (<63 µm) and few intermediate (63-124 µm) drusen, or RPE abnormalities.1-3

Intermediate

Extensive intermediate drusen (63-124 µm) or more than 1 large druse (≥125 µm). May also be accompanied by pigmentary and degenerative changes in the choriocapillaris, RPE, and photoreceptors.1-4

Advanced (GA)

Progressive atrophy of choriocapillaris, RPE, and photoreceptors.2,3 As well as new and growing lesions.3

Optical Coherence
Tomography (OCT)

Intermediate AMD

Image courtesy of Dr. Arshad Khanani

Advanced AMD (Geographic Atrophy)

Image courtesy of Dr. Arshad Khanani

Key Features1,4

  • (1) Degeneration of overlying photoreceptors increases reflectivity below Bruch’s membrane
  • (2) Hyperreflective foci corresponds to attenuation or disruption of the RPE
  • (3) Atrophy of the RPE
  • (4) Area of choroidal hypertransmission

Images are from separate patients.

Color Fundus Photography
(CFP)

Intermediate AMD

Image courtesy of Dr. Arshad Khanani

Advanced AMD (Geographic Atrophy)

Image courtesy of Dr. Mohammad Rafieetary

Key Features4-6

  • (1) Drusen and
  • (2) hyperpigmentary RPE abnormalities
  • (3) GA lesion borders are sharply demarcated with increased choroidal vessel visibility (dashed circle)

Images are from separate patients.

Fundus Autofluorescence
(FAF)

Intermediate AMD

Image courtesy of Dr. Arshad Khanani

Advanced AMD (Geographic Atrophy)

Image courtesy of Dr. David Lally

Key Features1,8

  • (1) Reticular pseudodrusen appearing as multiple, clustered, regularly networked, round areas of low-contrast hypo-autofluorescence may be prognostic of advancing AMD
  • (2) Abnormal patterns of
    hyperautofluorescence surrounding atrophic lesions
  • (3) Areas of hypoautofluorescence with sharply demarcated borders
    indicate atrophic lesions

Images are from separate patients.

References

  1. Holz FG, Schmitz-Valckenberg S, Fleckenstein M. Recent developments in the treatment of age-related macular degeneration. J Clin Invest. 2014;124(4):1430-1438.
  2. Boyer DS, Schmidt-Erfurth U, van Lookeren Campagne M, Henry EC, Brittain C. The pathophysiology of geographic atrophy secondary to age-related macular degeneration and the complement pathway as a therapeutic target. Retina. 2017;37(5):819-835.
  3. Fleckenstein M, Mitchell P, Freund KB, et al. The progression of geographic atrophy secondary to age-related macular degeneration. Ophthalmology. 2018;125(3):369-390.
  4. Sadda SR, Chakravarthy U, Birch DG, et al. Clinical endpoints for the study of geographic atrophy secondary to age-related macular degeneration. Retina. 2016;36(10):1806-1822.
  5. Monés J, Garcia M, Biarnés M, Lakkaraju A, Ferraro L. Drusen ooze: a novel hypothesis in geographic atrophy. Ophthalmol Retina. 2017;1(6):461-473.
  1. Ambati J, Ambati BK, Yoo SH, Ianchulev S, Adamis AP. Age-related macular degeneration: etiology, pathogenesis, and therapeutic strategies. Surv Ophthalmol. 2003;48(3):257-293.
  2. Flaxel CJ, Adelman RA, Bailey ST, et al. Age-related macular degeneration preferred practice pattern(R). Ophthalmology. 2020;127(1):P1-P65.
  3. Sunness JS, Rubin GS, Applegate CA, et al. Visual function abnormalities and prognosis in eyes with age-related geographic atrophy of the macula and good visual acuity. Ophthalmology. 1997;104(10):1677-1691.
  4. Lindblad AS, Lloyd, PC, Clemons TE, et al. Change in area of geographic atrophy in the Age-Related Eye Disease Study: AREDS report number 26. Arch Ophthalmol. 2009;127(9):1168-1174.
  5. Holz FG, Strauss EC, Schmitz-Valckenberg S, van Lookeren Campagne M. Geographic atrophy: clinical features and potential therapeutic approaches. Ophthalmology. 2014;121(5):1079-1091.
  6. Desai D, Dugel PU. Complement cascade inhibition in geographic atrophy: a review. Eye (Lond). 2022;36(2):294-302.
  7. Bakri SJ, Bektas M, Sharp D, Luo R, Sarda SP, Khan S. Geographic atrophy: mechanism of disease, pathophysiology, and role of the complement system. J Manag Care Spec Pharm. 2023;29(5-a Suppl):S2-S11.
  8. Carlton J, Barnes S, Haywood A. Patient perspectives in geographic atrophy (GA): exploratory qualitative research to understand the impact of GA for patients and their families. Br Ir Orthopt J. 2019;15(1):133-141.
  9. Stahl A. The diagnosis and treatment of age-related macular degeneration. Dtsch Arztebl Int. 2020;117(29-30):513-520.
  10. Sayegh RG, Sacu S, Dunavölgyi R, et al. Geographic atrophy and foveal-sparing changes related to visual acuity in patients with dry age-related macular degeneration over time. Am J Ophthalmol. 2017;179:118-128.
  11. Chakravarthy U, Bailey CC, Johnston RL, et al. Characterizing disease burden and progression of geographic atrophy secondary to age-related macular degeneration. Ophthalmology. 2018;125(6):842-849.
  12. Patel PJ, Ziemssen F, Ng E, et al. Burden of illness in geographic atrophy: a study of vision-related quality of life and health care resource use. Clin Ophthalmol. 2020;14:15-28.
  13. Singh RP, Patel SS, Nielsen JS, Schmier JK, Rajput Y. Patient-, caregiver-, and eye care professional-reported burden of geographic atrophy secondary to age-related macular degeneration. Am J Ophthalmic Clin Trials. 2019;2(1):1-6.
  14. Sivaprasad S, Tschosik EA, Guymer RH, et al. Living with geographic atrophy: an ethnographic study. Ophthalmol Ther. 2019;8(1):115-124.
  15. Higgins BE, Taylor DJ, Binns AM, Crabb DP. Are current methods of measuring dark adaptation effective in detecting the onset and progression of age-related macular degeneration? A systematic literature review. Ophthalmol Ther. 2021;10(1):21-38.
  16. Meleth AD, Mettu P, Agron E, et al. Changes in retinal sensitivity in geographic atrophy progression as measured by microperimetry. Invest Ophthalmol Vis Sci. 2011;52(2):1119-1126.
  17. Xu H, Chen M. Targeting the complement system for the management of retinal inflammatory and degenerative diseases. Eur J Pharmacol. 2016;787:94-104.
  18. Coulthard LG, Woodruff TM. Is the complement activation product C3a a proinflammatory molecule? Re-evaluating the evidence and the myth. J Immunol. 2015;194(8):3542-3548.
  19. Xie CB, Jane-Wit D, Pober JS. Complement membrane attack complex: new roles, mechanisms of action, and therapeutic targets. Am J Pathol. 2020;190(6):1138-1150.
  20. Brandstetter C, Holz FG, Krohne TU. Complement component C5a primes retinal pigment epithelial cells for inflammasome activation by lipofuscin-mediated photooxidative damage. J Biol Chem. 2015;290(52):31189-31198.
  21. Kumar-Singh R. The role of complement membrane attack complex in dry and wet AMD – from hypothesis to clinical trials. Exp Eye Res. 2019;184:266-277.

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Last updated: April 2026

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      5. Any relevant limitations period and filing fee or other deadlines will be tolled during the Negotiation Period, which may be extended by written agreement of the parties.
    3. The arbitration of any claim or dispute hereunder (including whether a valid arbitration agreement exists and whether it covers the dispute) will be administered by JAMS in accordance with the then-current Streamlined Arbitration Rules and Procedures (available at https://www.jamsadr.com/rules-streamlined-arbitration/) and, if you are an individual, in accordance with JAMS’ Consumer Arbitration Minimum Standards (available at https://www.jamsadr.com/consumer-minimum-standards/)(as applicable, the “JAMS Rules”). If the JAMS Rules conflict with any portion of these Terms of Use, these Terms of Use shall control. The parties will mutually agree on an arbitrator, provided that if the parties cannot agree on an arbitrator within ten (10) days, JAMS will choose the arbitrator. The arbitration of any claims or disputes hereunder must be conducted in Wilmington, Delaware, except that if you are an individual the arbitration may be conducted in the county or parish of your primary residence. You or we also may choose to have the arbitration conducted by telephone, based on written submissions, or in person at another mutually agreed location. Payment of all filing, administration, and arbitrator fees will be governed by the JAMS Rules. In rendering an award, the arbitrator shall apply the governing law stated in the Applicable Law section below, except that the Federal Arbitration Act will govern the interpretation and enforcement of this Section.
    4. Unless you opt-out of arbitration as set forth below, and except with respect to the class arbitration waiver as set forth below, the arbitrator, and not any federal, state, or local court, will have exclusive authority to resolve any dispute relating to interpretation, applicability, unconscionability, formation, arbitrability, and/or enforceability of this arbitration provision, including any challenge that the arbitration provision or these Terms of Use is void, voidable, or otherwise invalid. There is no judge or jury in arbitration, the arbitration will be subject to different rules than the rules that would apply in court, and court review of arbitration awards is very limited. However, the arbitrator will be empowered to grant whatever relief would be available in court under law or in equity (including injunctive and declaratory relief and statutory damages) and must follow these Terms of Use, as a court would. Any award of the arbitrator(s) will be final and binding on each of the parties, and may be entered as a judgment in any court of competent jurisdiction.
    5. You agree that an arbitration will be conducted on an individual, and not a class-wide, basis. An arbitrator will have no authority to certify a class or award class-wide relief. The arbitrator is authorized only to award relief on behalf of the individual parties and only to their extent of their individual claims. YOU ACKNOWLEDGE AND AGREE THAT UNLESS OTHERWISE AGREED IN WRITING BY YOU AND ASTELLAS, WITH REGARD TO ANY CLAIMS HEREUNDER, YOU WILL NOT BE ENTITLED TO SEEK TO, AND AN ARBITRATOR OR COURT MAY NOT, JOIN OR CONSOLIDATE YOUR CLAIMS WITH ANY OTHER SIMILAR CLAIMS OF ANY OTHER PERSON OR PARTICIPATE IN ANY CLAIM AS A CLASS REPRESENTATIVE, CLASS MEMBER, OR IN A PRIVATE ATTORNEY GENERAL CAPACITY. Your waiver of your rights to bring or participate in court proceedings and as a representative or member of a class applies specifically, but is not limited to, claims brought under California’s Unfair Competition Law, False Advertising Act and its Consumer Legal Remedies Act, Ohio’s Unfair and Deceptive Trade Practices Act and any other state consumer protection laws.
    6. The arbitrator shall be empowered to award the prevailing party any remedy available at law or in equity not specifically precluded by these Terms of Use, including without limitation injunctive or declaratory relief, specific performance, and damages. The arbitrator’s award will consist of a written statement stating the disposition of each claim. The award also will provide a concise written statement of the essential findings and conclusions on which the award is based. Each party shall pay its own fees and costs of its own attorneys, experts and witnesses incurred in connection with any arbitration or court proceeding between the parties, notwithstanding any provision awarding attorneys’ fees to a prevailing party that may be a part of any statute under which you or we may bring a claim. The award of the arbitrator may be entered as a judgment in any court of competent jurisdiction.
    7. YOU AND WE SPECIFICALLY ACKNOWLEDGE AND AGREE THAT EACH OF US EXPRESSLY WAIVES THE RIGHT TO BRING A LAWSUIT IN COURT BASED ON ANY CLAIMS OR DISPUTES DESCRIBED ABOVE, AND THAT YOU AND WE EXPRESSLY WAIVE THE RIGHT TO HAVE SUCH CLAIMS OR DISPUTES RESOLVED BY A JUDGE OR JURY OR TO PARTICIPATE IN A CLASS ACTION. AS SUCH, YOU AND WE HEREBY AGREE TO RESOLVE ANY AND ALL SUCH CLAIMS DESCRIBED ABOVE VIA INDIVIDUAL BINDING ARBITRATION PER THE TERMS AND CONDITIONS SET FORTH IN THIS SECTION.
    8. You can opt out of this arbitration provision within sixty (60) days of the date that you first agreed to these Terms of Use or to any subsequent revisions to this Section. If you opt out of a subsequent revision, you will remain bound by the prior version of this Section unless you previously opted out of that version. To opt out, you must send your name, address, username, the email address, or phone number associated with your account, and a clear statement that you want to opt out of this arbitration agreement to GCO@astellas.com. You may opt out of these Terms of Use in their entirety by not using HYPERCEPT™.
    9. Any action or claim against us must be brought within one year following the date on which the claim first accrued or shall be deemed forever waived.
  18. Applicable Law and Venue
    1. All matters relating to HYPERCEPT™ or these Terms of Use, and any dispute or claim between the parties arising out of or related to HYPERCEPT™ or these Terms of Use (in each case, including non-contractual disputes or claims), are governed by and will be construed in accordance with the laws of the United States and the State of Delaware, without regard to Delaware’s conflict of laws principles.
    2. If for any reason, a claim proceeds in court rather than arbitration as provided in Section 17 above, the claim shall be resolved exclusively (except as provided below) in the appropriate state and federal courts located in Wilmington, Delaware. Both parties hereby irrevocably consent to the venue and jurisdiction of such courts, and waive all defenses, including without limitation for lack of personal jurisdiction and forum non conveniens, with respect to such courts for the adjudication of such claims. YOU AND WE EXPRESSLY WAIVE THE RIGHT TO A JURY TRIAL IN CONNECTION WITH ANY SUCH LAWSUIT AND AGREE THAT NO SUCH LAWSUIT CAN BE BROUGHT AS A CLASS ACTION OR OTHER REPRESENTATIVE ACTION.
    3. Notwithstanding anything else in Section 17 or this Section 18 to the contrary, the following claims may be brought in any court of competent jurisdiction: claims in court to seek temporary or preliminary injunctive relief in aid of arbitration and without seeking damages.
  19. Severability

    If any provision or part of a provision of the Terms of Use is contrary to law, the remaining part of the provision and the remaining provisions of the Terms of Use will remain in effect.

  20. Notice

    All formal notices to us shall be sent to:

    Astellas Pharma US, Inc.
    Attention: General Counsel’s Office
    2375 Waterview Drive
    Northbrook, IL 60062-6111

    All notices to you shall be sent to the email address that you provide when you register for HYPERCEPT™. By registering for HYPERCEPT™, you consent to receive communications from us electronically and agree that any electronic communications satisfy any requirement that those communications be in writing. Any notice provided under the Terms of Use shall be deemed given one business day after the email is sent. If you do not register, or register with inaccurate information, you hereby waive any right to notice for any purpose related to the Terms of Use or HYPERCEPT™.

  21. Further Contact

    If you have an inquiry regarding the functionality of HYPERCEPT™, you may contact us as follows: support@hypercept-ga.com.

  22. Assignment

    You may not assign, by operation of law or otherwise, any rights or delegate any duties under the Terms of Use to any third party without prior written consent by us.  Any purported assignment lacking such consent will be void at its inception.  We may assign all or part of its rights and/or delegate all or part of its duties under the Terms of Use to any party, at any time, and in its sole discretion, upon notice of assignment by posting such notice in HYPERCEPT™.

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