Evaluating Progressive Multifocal Geographic Atrophy in an Asymptomatic 81-Year-Old Male

In this segment, the expert faculty review a case involving an 81-year-old male referred for AMD evaluation with good visual acuity but bilateral fovea-sparing geographic atrophy (GA). Although asymptomatic, multimodal imaging revealed active atrophic lesions with hyperfluorescent borders—features associated with higher progression risk. The panel underscores how management decisions have evolved since this patient was first seen in 2022, when no GA therapies were available. After the patient was lost to follow-up and later returned in 2024, imaging clearly demonstrated lesion enlargement and new areas of atrophy, confirming earlier concerns. This progression informed the decision to initiate monthly avacincaptad in both eyes. The faculty emphasize the importance of shared decision-making, discussing treatment burden, and setting realistic expectations—namely, that GA therapies slow but do not stop progression. They also stress the need to counsel patients early and consistently about the likelihood of continued enlargement despite treatment to preserve adherence and trust.