Summary for the Clinician

›Natural history studies in patients with geographic atrophy have identified various predictive markers for the rate of atrophy enlargement over time, while no correlation between GA spread and systemic factors has been established so far.

›Predictive markers as prognostic determinants are particularly useful for the design of interventional trials. Recruitment of “fast progressers” can decrease sample size and observation periods.

›Fundus autofluorescence (FAF) imaging currently represents the gold standard for imaging patients with geographic atrophy. It is particularly helpful to identify atrophic lesion, quantify progression over time, and to detect perilesional abnormal patterns of autofluorescence that in part predict enlargement rates.

›Assessment of visual impairment in the presence of foveal sparing, variable location of paracentral scotoma, and changing fixation is challenging.

›New imaging technologies with combined confocal scanning laser ophthalmoscopy and spectraldomain optical coherence tomography allows for more accurate and three-dimensional mapping on a quasi-histological level of microstructural alterations. Investigations with these imaging tools may help to further improve the understanding of relevant pathophysiological mechanisms.

›Increasing interest is focused on developing and testing new therapeutic agents to slow or halt the disease process.

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