Geographic atrophy (GA), the late-stage of non-neovascular age-related macular degeneration, is characterized by progressive degeneration of photoreceptors, retinal pigment epithelium, and the choriocapillaris, ultimately leading to irreversible central vision loss. Advances in multimodal imaging, particularly the optical coherence tomography (OCT) based definition of complete retinal pigment epithelium and outer retinal atrophy (cRORA), have substantially improved the diagnostic consistency of GA. The recent approval of complement inhibitors, pegcetacoplan (complement C3 inhibitor) and avacincaptad pegol (complement C5 inhibitor) marks a treatment milestone, demonstrating efficacy in slowing atrophy progression. However, the efficacy of existing drugs still mainly focuses on structural endpoints, with limited protective effects on functions. This reveals the core challenge of "structural-function dissociation" in GA. In recent years, attention has been drawn to early endpoints such as incomplete retinal pigment epithelium and outer retinal atrophy transforming into cRORA; sensitive functional assessment tools such as micro-perimetry, as well as artificial intelligence-assisted OCT stratified analysis and individualized progression prediction models, have also continuously expanded the assessment and management capabilities of GA. Additionally, diverse treatment strategies such as gene therapy, stem cell transplantation, and neurotrophic protection are also being actively explored, further broadening the future intervention pathways. It is worth noting that the prevalence and clinical manifestations of GA in Asian populations are significantly different from those in Western populations, suggesting that the disease characteristics and mechanisms may have racial specificity. Currently, there is a lack of systematic local data in China, and it is urgent to establish a multicenter longitudinal cohort based on cRORA criteria, and incorporating multimodal imaging and functional assessments, to facilitate GA characterization, risk prediction, and the development of individualized intervention strategies in the Chinese population.

Citation： Chen Youxin, Zhang Chenxi. Improving the understanding of geographic atrophy: disease nature, diagnostic and therapeutic advances, and future perspectives. Chinese Journal of Ocular Fundus Diseases, 2026, 42(6): 474-478. doi: 10.3760/cma.j.cn511434-20251222-00594 Copy

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