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Geographic atrophy is an advanced form of AMD1\u20133<\/sup> that causes progressive, irreversible degeneration of the macula.3\u20136<\/sup> The global prevalence of AMD is growing at an exponential rate.2<\/sup><\/p>\n<\/div><\/div>\n\n\n\n\n
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AMD is a leading cause of permanent vision loss8<\/sup><\/h2>\n<\/div>\n\n\n
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In 2020, the leading causes were cataract, followed by glaucoma, undercorrected refractive error, AMD and diabetic retinopathy.8<\/sup><\/p>\n<\/div>\n\n\n
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Causes of permanent vision loss in those aged 50+<\/strong><\/p>\n<\/div>\n\n\n
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Adapted from GBD 2019.8<\/sup><\/p>\n<\/div>\n\n\n
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Among these global cases of AMD, the number of patients diagnosed with geographic atrophy cases is expected to almost quadruple \u2013 rising from 5 million to more than 18 million by 2040.2,3<\/sup><\/p>\n<\/div>\n\n\n
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Causes of permanent vision loss in those aged 50+<\/strong><\/p>\n<\/div>\n\n\n
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Adapted from GBD 2019.8<\/sup><\/p>\n<\/div><\/div>\n\n\n\n\n
In 2020, the leading causes were cataract, followed by glaucoma, undercorrected refractive error, AMD and diabetic retinopathy.8<\/sup><\/p>\n<\/div>\n\n\n
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Among these global cases of AMD, the number of patients diagnosed with geographic atrophy cases is expected to almost quadruple \u2013 rising from 5 million to more than 18 million by 2040.2,3 <\/sup><\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n\n\n
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Forms of advanced AMD<\/h2>\n<\/div>\n\n\n
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Advanced AMD has two forms: geographic atrophy and choroidal neovascularisation (wet AMD).9<\/sup><\/p>\n<\/div>\n\n\n
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Advanced AMD is less prevalent than the early and intermediate stages,10<\/sup> however, it is often highly symptomatic and can lead to permanent vision loss.7<\/sup><\/p>\n<\/div><\/div>\n\n\n\n\n
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Geographic atrophy (GA) and wet AMD are considered different manifestations of advanced AMD but can occur simultaneously in the same eye. Patients with GA can naturally develop wet AMD.9<\/sup><\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n\n\n
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Causes of geographic atrophy<\/h2>\n<\/div><\/div>\n<\/div><\/div>\n\n\n
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AMD is a complex, multifactorial disease and GA pathogenesis encompasses a complex interaction of genetic, physiological and environmental factors.11\u201314<\/sup><\/p>\n<\/div><\/div>\n<\/div><\/div>\n\n\n
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Genetics<\/strong><\/p>\n<\/div>\n\n\n
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Drusen formation<\/li>\n<\/div>\n\n\n
Formation of reactive oxygen species<\/li>\n<\/div>\n\n\n
Inflammation<\/li>\n<\/div>\n\n\n
Immune response, including complement<\/li>\n<\/div><\/ul>\n<\/div><\/div>\n\n\n\n\n
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Physiology<\/strong><\/p>\n<\/div>\n\n\n
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Age is the greatest risk factor for GA<\/li>\n<\/div><\/ul>\n<\/div><\/div>\n\n\n\n\n
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Environment<\/strong><\/p>\n<\/div>\n\n\n
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Sunlight, smoking and diet<\/li>\n<\/div>\n\n\n
High alcohol intake<\/li>\n<\/div><\/ul>\n<\/div><\/div>\n<\/div>\n<\/div>\n\n\n
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Assessing AMD severity and risk of progression<\/h2>\n<\/div>\n\n\n
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The Beckman classification system recognises an increasing risk of developing advanced AMD.15<\/sup> This system only requires a clinical examination or colour fundus image to observe and analyse retinal abnormalities.16<\/sup><\/p>\n<\/div>\n\n\n
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Beckman clinical classification of AMD<\/strong><\/p>\n<\/div>\n\n\n
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Adapted from Ferris III et al.<\/em> 2013.15<\/sup><\/p>\n<\/div>\n\n\n
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Classification is based on assessment of fundus lesions within two disc diameters of the fovea in people over 55 years of age. The presence of large drusen (>125 \u03bcm) and\/or pigmentary abnormalities indicate intermediate AMD with a high risk of progression to advanced AMD.15<\/sup><\/p>\n<\/div>\n\n\n
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Assessing your patients with the Beckman scale avoids ambiguity as to the staging of AMD and supports consistent classification.16<\/sup><\/p>\n<\/div>\n\n\n
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*AMD pigmentary abnormalities are defined as any definite hyper- or hypopigmentary abnormalities associated with medium or large drusen but not associated with known disease entities.15<\/sup><\/p>\n<\/div>\n\n\n
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Diagnosis of geographic atrophy<\/h2>\n<\/div>\n\n \n