Monocular, High-Risk Geographic Atrophy Managing for Vision Preservation

Dr. Sambhara presents an 82-year-old monocular woman with non-foveal geographic atrophy (GA) in her only seeing eye; the fellow eye is hand-motion from prior wet AMD, advanced glaucoma, and postsurgical complications. He reviews key high-risk growth features—non-foveal location, multifocal lesions, and perilesional hyperautofluorescent rims—and polls colleagues on dosing approaches. Given the high stakes of a monocular patient, he selects avacincaptad pegol (ACP) over pegcetacoplan, prioritizing the safety profile in this scenario. Over 12 months of q8-week ACP therapy, multimodal imaging (OCT/FAF) documents gradual lesion enlargement—most notably peripapillary consolidation—without foveal involvement and with stable visual acuity. Side-by-side imaging from two years prior to treatment underscores how much faster progression was pre-therapy, reinforcing the clinical value of early intervention, close imaging surveillance, and visualizing disease stability to sustain patient commitment.