Decision Day: Choosing Treatment for Geographic Atrophy

I was diagnosed with advanced dry macular degeneration, also known as geographic atrophy (GA), in July 2023. I immediately talked to my retina specialist about Syfovre, the first-ever treatment for GA. My retina specialist was reluctant to have me begin treatment with this medication because of the side effects. He said if I were his mother, he would not recommend it. That made my decision easy. I have the best retina specialist and trust his judgment.

I used the following 4 months to research all the available options.

Considering vitrectomy

My doctor wanted me to consider a procedure called vitrectomy to remove the floaters from my right eye. The presence of a large number of floaters is darkening my vision. That is a big problem, especially with loss of central vision. This surgery has a difficult recovery process and risk of complications. I knew firsthand about vitrectomy surgery because my husband had one to close a macular hole.

Weighing the risks of medications

While I waited for my appointment day, a second injectable medication, Izervay, was approved by the FDA. Now I had a choice between Syfovre and Izervay. Both drugs have been shown to slow the progression of GA by up to 35 and 36 percent. Both also carry the risk of rare but serious side effects.¹

Seeing the difference in my OCT scans

On December 26, 2023, my much-anticipated appointment arrived.

I was especially nervous about this appointment. My initial eye exam by the tech brought shocking news: My right eye had progressed from 20/70 to 20/150. Tears sprang to my eyes as I wondered if this meant the end of driving.

Next up was the OCT scan. Once in the exam room, the results were displayed on a computer screen next to the previous scan. Before GA, the scan showed little humps. With GA, the humps have flattened out and look moth-eaten. I know from previous conversations with my doctor that this will worsen as the lesion grows in size.

Vitrectomy would be a last resort

My retina specialist arrived, and I immediately brought up my concern about the eye exam. He told me not to be too concerned about one exam, since vision fluctuates.

Next topic was the treatment options. Once again, he mentioned a vitrectomy. I would need to travel 5 hours away for surgery. I shared with my doctor that a vitrectomy would be a last resort because of the difficult recovery and the burden of travel.

I am the captain of my treatment plan

We discussed Syfovre and Izervay. I asked for his recommendation as to which medication I should choose. He said that after several months of using both medications with patients, he had seen no adverse effects. He was comfortable giving either medication.

He explained we were a team. He was the pilot, but I was the captain and in charge of treatment decisions. I told him I liked it better when we pretended I was his mother and he made the decision for me.

After a few moments of thought, I chose to begin treatment with Izervay. A new phase of my life with macular degeneration had begun.