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The content and opinions expressed in Reframe GA are entirely those of the authors. The Reframe GA initiative was organised and funded by Astellas Pharma Inc., which also provided editorial input to the final report. Writing support was provided by Havas.
This website is intended for healthcare professionals, patient advocacy groups, and other relevant decision makers such as payers, regulators, and policy makers.

Reframe GA

A manifesto for change in geographic atrophy

A manifesto for change in geographic atrophy
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We want to hear from you

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9 experts share their perspective on GA care – and what needs to change

The clinical landscape of geographic atrophy (GA) is evolving. What was previously seen as an untreatable condition is now entering a new phase of therapeutic potential.1,2 Recent consensus statements have begun to explore important questions around diagnosis, prognosis, and treatment

strategies.3,4 However, critical gaps remain. One issue that sits at the centre is the lack of understanding needed to connect the complex structure of GA to its impact on visual function, long-term outcomes, and – most importantly – the lived experience of patients.3,4

Reframe GA is a call to action for meaningful change. It brings together expert perspectives to spotlight the key challenges we face to outline practical, actionable steps toward improving care for people living with GA.

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By working together, we can reframe GA. Read our white paper and join the change.

The four key issues in GA

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We need a clearer definition of GA

Current classification of all forms of age-related macular degeneration (AMD), and particularly of GA, does not reflect the full complexity of the disease.5,6 A refined and universally-accepted definition of GA could help us with establishing accurate diagnosis and prognosis in patients, improving clinical trial design, and in determining optimal clinical management.

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Too few truly understand GA and its management

Many healthcare professionals, including some involved in shaping policy, regulatory decisions, and commissioning services, lack hands-on experience with GA. Even among retina specialists, hands-on familiarity can be limited.7 If we are to deliver appropriate patient counselling, insightful interpretation of clinical trials, and optimised patient care, this needs to change.

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We don’t have the proper tools

Visual acuity remains the gold standard measure for visual function, particularly in conditions like neovascular AMD.8–11 But in GA, visual acuity fails to capture the early loss of visual function, particularly across the heterogenous patient populations that are characteristic of this condition.11,12 Because visual acuity is often preserved until late in disease progression, other aspects of visual function frequently go unmeasured and any losses may be overlooked.10,11 Without an accurate means of assessing the functional impact of GA, how can we identify those patients who might benefit most from clinical management? We need validated, GA-specific tools.

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Early patient referral is important – but not always achieved

In some countries, there is little or no follow-up or specialist referral for GA.7 For countries that do, patients often have no specialist attention until they are already experiencing symptoms of central vision loss. We must recognise fast progressing, extrafoveal GA lesions earlier before visual function is compromised.

Our call to change

Six ways we can reshape the future of GA care

Building on the four key issues, we outline six focused proposals to drive real change in how GA is understood and managed.

Explore the proposals:

redefine ga

Redefine GA

Update classification of AMD and GA to guide appropriate diagnosis, referral and management, improve study of potential treatments and better identify patient subgroups.

improve understanding

Improve understanding

Provide greater access to specialist education on how GA differs from neovascular AMD, characterise GA natural history, and improve understanding of GA’s variable anatomical features. Only then can we understand the implications these differences have for the visual function of the individual patient, the heterogeneity of the overall GA population, and patient care.

endpoint-v1

Rethink endpoints

Support research into validated measures that reflect how GA really impacts visual function and the subsequent effects on patients’ lives.

key subgroup

Prioritise key subgroups

Identify patient subgroups that may be:

  • Likely to benefit from early clinical management
  • At higher risk of potential disease progression

regulators

Collaborate with payers and regulators

Invite payers and regulators to work more closely with GA expert specialists to better interpret data and apply insights from other disease areas.

refer earlier

Refer earlier

Focus on prompt recognition and management of GA patients before central vision may be compromised.

Background to Reframe GA

Reframe GA was established in 2024 with organising and funding support from Astellas and the goal of igniting a collaborative movement for change in GA

Background to Reframe GA

Following extensive desk research to identify emerging challenges and research advances in GA, nine experts were brought together to explore key aspects of GA and its management, including how better to measure and monitor disease progression and visual function.


Each expert was interviewed on a one-to-one basis to identify what they felt were the key issues in GA and any potential avenues available for their resolution.


From these conversations, a powerful, purpose-driven agenda emerged, setting the stage for a roundtable aimed not just at diagnosing the challenges facing the GA community, but at identifying real, pragmatic solutions – that go beyond consensus. On this basis, the white paper was created.

Background to Reframe GA

The content and opinions expressed in Reframe GA are entirely those of the authors. The Reframe GA initiative was organised and funded by Astellas Pharma Inc., which also provided editorial input to the final report. Writing support was provided by Havas.

AMD, age-related macular degeneration; GA, geographic atrophy.

1. Sivaprasad S, et al. Perspectives from Clinical Trials: is Geographic Atrophy One Disease? Eye 2023;37:402–7.

2. Heier JS, et al. Pegcetacoplan for the Treatment of Geographic Atrophy Secondary to Age-Related Macular Degeneration (OAKS and DERBY): Two Multicentre, Randomised, Double-Masked, Sham-Controlled, Phase 3 Trials. Lancet. 2023;402:1434–8.

3. Kaiser PK, et al. Geographic Atrophy Management Consensus (GA-MAC): a Delphi Panel Study on Identification, Diagnosis and Treatment. BMJ Open Ophthalmol 2023;8:e001395 and supplementary appendix.

4. Singh RP, et al. Diagnosis and Management of Patients with Geographic Atrophy Secondary to Age-Related Macular Degeneration: a Delphi Consensus Exercise. Ophthalmic Surg Lasers Imaging Retina 2023;54:589–98.

5. Ferris FL, et al. Clinical Classification of Age-related Macular Degeneration. Ophthalmology 2013;120(4):844–51.

6. Guymer RH, et al. Incomplete Retinal Pigment Epithelial and Outer Retinal Atrophy in Age-Related Macular Degeneration: Classification of Atrophy Meeting Report 4. Ophthalmology 2020;127(3):394–409.

7. Royal College of Ophthalmologists (2024). Commissioning Guidance. Age Related Macular Degeneration Services: Recommendations. May 2024. Available at: https://www.rcophth.ac.uk/wp-content/uploads/2021/08/AMD-Services-Commissioning-Guidance-Recommendtions.pdf [Last accessed: July 2025].

8. Schmetterer L, et al. Endpoints for Clinical Trials in Ophthalmology. Prog Retin Eye Res 2023;97:101160.

9. Chong V. Edridge Green Lecture 2022 – Demystifying Clinical Trials and Regulatory Approvals in Drug Development. Eye 2025;39:484–7.

10. Chew EY, et al. Assessing Structure – Function Relationships in Non-Neovascular Age-Related Macular Degeneration. Exp Eye Res 2025;255:110349.

11. Sadda SR, et al. Clinical Endpoints for the Study of Geographic Atrophy Secondary to Age-Related Macular Degeneration. Retina 2016;36(10):1806–22.

12. Sunness JS, et al. The Long-Term Natural History of Geographic Atrophy from Age-Related Macular Degeneration: Enlargement of Atrophy and Implications for Interventional Clinical Trials. Ophthalmology 2007;114(2):271–7.

MAT-GB-NON-2025-00415 | August 2025.