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Izervay for Geographic Atrophy: What Patients Need to Know
What Is Geographic Atrophy?
Geographic atrophy is a serious, slowly progressive condition affecting the central retina. Understanding what it involves helps explain why a treatment like Izervay was developed and what it is working to accomplish for patients living with this diagnosis.
Geographic atrophy is the advanced stage of dry AMD. It involves the gradual breakdown of cells in the macula, the central portion of the retina responsible for sharp, detailed vision. Two key cell types are affected: the retinal pigment epithelium (RPE), a support layer that nourishes and maintains the light-sensing cells, and the photoreceptors themselves, which are the cells that make vision possible. As these cells die, areas of the retina stop functioning and expand over time, creating blind spots in central vision.
Because geographic atrophy progresses slowly, early changes can be subtle. Common signs include increasing difficulty reading fine print, growing dark or blank spots in the center of your vision, and trouble recognizing faces in low light. These symptoms tend to worsen gradually as affected areas enlarge.
If damage reaches the fovea, which is the very center of the macula and the point responsible for the sharpest detail, central vision can become significantly impaired. Regular monitoring with your retina specialist helps track these changes before they affect daily life.
Geographic atrophy does not reverse on its own, and the cell loss it causes is permanent. Treatment with Izervay does not restore vision that has already been lost. What it can do is slow the rate at which additional retinal tissue is destroyed, with the goal of preserving the vision you still have for as long as possible. Evidence from long-term studies suggests that earlier treatment initiation may provide greater cumulative benefit over time.
How Izervay Works
Izervay targets a specific part of the immune system that becomes overactive in geographic atrophy. Understanding this mechanism helps clarify why this treatment is appropriate for GA and not for other retinal conditions.
The complement system is a branch of the body's immune defense. Under normal conditions, it helps fight infections and clear away damaged cells. In geographic atrophy, this system becomes chronically overactive in the retina. Instead of protecting the eye, it drives ongoing inflammation and destruction of RPE cells and photoreceptors. This immune-driven process is different from conditions like wet AMD, where abnormal blood vessel growth is the primary problem.
Avacincaptad pegol is a type of molecule known as an RNA aptamer, designed to bind specifically to complement protein C5. C5 is a key protein activated near the end of the complement cascade, a chain of immune reactions. When C5 is activated, it splits into two fragments called C5a and C5b. These fragments trigger the final destructive step: the formation of the membrane attack complex (MAC), a structure that damages retinal cell membranes and leads to cell death.
By binding to C5 before this split occurs, Izervay blocks the most damaging phase of complement activity. Importantly, it does this without disabling earlier parts of the complement system, which continue to perform protective immune functions throughout the body.
Izervay slows the rate at which geographic atrophy lesions grow. A lesion is an area of the retina where RPE cells and photoreceptors have already been lost. Slowing lesion growth means preserving more of the retinal tissue that remains. Clinical trials showed that treatment reduced the rate of lesion growth measurably, but improvements in visual acuity (standard eye chart sharpness) were not demonstrated in the trial populations. The goal of treatment is protection and preservation, not recovery of function that has already been lost.
What the Clinical Evidence Shows
Izervay was evaluated in two major clinical trials known as GATHER1 and GATHER2, followed by a long-term extension study. Together, these studies provide a picture of both the short-term and long-term effects of treatment on geographic atrophy progression.
The GATHER1 Phase 2/3 trial compared monthly avacincaptad pegol injections to sham (placebo) procedures in patients with geographic atrophy. At 12 months, patients receiving monthly treatment showed a 35% reduction in the rate of geographic atrophy lesion growth compared to the sham group. This was an important early demonstration that blocking complement C5 could meaningfully slow the expansion of retinal cell loss.
The GATHER2 Phase 3 trial enrolled 448 patients and provided a larger, more rigorous confirmation of the treatment's effects. At 12 months, monthly Izervay reduced lesion growth rates by 18% compared to sham. At 24 months, the mean reduction in lesion growth rate compared to sham was 14%. Evidence of disease slowing was already apparent as early as six months into treatment.
An open-label extension study following patients from GATHER2 tracked outcomes for up to 3.5 years. Patients who received early and continuous treatment showed a 40.5% reduction in disease progression compared to projected outcomes in an untreated group at the 3.5-year mark. These patients preserved approximately 2.92 square millimeters of retinal tissue area relative to what would have been expected without treatment.
Patients who had originally received sham procedures and later switched to active treatment showed a 37% reduction in progression. The gap between early starters and late starters suggests that beginning treatment sooner offers a greater cumulative benefit over time.
These figures reflect changes in the rate of lesion growth on imaging, not changes in how clearly you can see on a day-to-day basis. The benefit of treatment builds gradually and may not be something you notice in your daily vision. Your retina specialist will use imaging to measure lesion size over time and help you understand whether treatment is having its expected effect. Setting realistic expectations early helps patients stay committed to a long-term care plan.
What the Injection Procedure Involves
Izervay is administered as an intravitreal injection, meaning the medication is delivered directly into the vitreous, the gel-filled interior of the eye. The procedure is performed in our office and is designed to be as quick and comfortable as possible.
Before the injection, your retina specialist will apply anesthetic (numbing) drops to the surface of your eye. The eye is then cleaned with an antiseptic solution to reduce infection risk. Some patients also receive a small amount of additional numbing medication around the eye. The preparation process takes a few minutes, and most patients find the overall experience manageable with these precautions in place.
The injection itself takes only a few seconds. A thin needle is used to deliver the medication through the sclera (the white part of the eye) into the vitreous cavity. Most patients describe the sensation as brief pressure rather than sharp pain. Your full appointment, including preparation and a short monitoring period afterward, generally lasts between 30 and 60 minutes.
Mild discomfort, a gritty or scratchy sensation, or temporary blurred vision is common in the hours after the procedure. You may also notice floaters (small moving shapes in your field of vision) for a short time. These effects usually settle within a few hours to a day. Your retina specialist will check your eye pressure before you leave the office.
You can return to most normal activities the same day. To reduce infection risk in the days that follow, we recommend the following precautions:
- Avoid rubbing your eye for the rest of the day
- Stay away from swimming pools, hot tubs, and dusty or dirty environments for a few days
- Use preservative-free artificial tears if your eye feels dry or irritated
If you have any concerns after returning home, do not hesitate to contact our office.
Your Treatment Schedule and Monitoring
Geographic atrophy is a chronic condition that requires a consistent, long-term approach to treatment. Knowing what your schedule involves and why regular monitoring matters will help you stay engaged in your care.
Izervay is given once per month as an intravitreal injection. This monthly dosing schedule was used in both pivotal clinical trials that supported FDA approval, and consistent monthly treatment was associated with greater benefit over time. Your retina specialist will establish a regular appointment schedule with you. Keeping these appointments is an important part of maintaining the slowing effect on disease progression.
Because geographic atrophy is a progressive condition that does not resolve on its own, long-term treatment is typically needed to sustain the slowing of lesion growth. The February 2025 FDA label update for Izervay removed previous limitations on treatment duration, reflecting the understanding that many patients will benefit from ongoing therapy. Extension study data showed that patients who continued treatment maintained the slowing of disease progression across 3.5 years of follow-up. If treatment is stopped, the disease is expected to resume its natural rate of progression.
At each visit, your retina specialist will use diagnostic imaging to monitor the condition of your retina. Optical coherence tomography (OCT), a non-invasive scan that produces detailed cross-sectional images of the retina, and fundus autofluorescence imaging, which highlights areas of retinal cell loss, are commonly used to measure lesion size and track changes over time. These tests help confirm whether treatment is having its expected effect and allow your specialist to detect any developing complications early. Regular imaging is an essential component of care, not simply a formality.
Benefits, Risks, and Safety
As with any medical treatment, Izervay carries both potential benefits and risks. Your retina specialist will review these with you individually and help you weigh them in the context of your specific condition and imaging findings.
Izervay is one of only two FDA-approved treatments shown to slow the progression of geographic atrophy. By reducing the rate at which lesions expand, it works to preserve the retinal tissue that remains. Long-term extension data indicates that the protective benefit accumulates with consistent treatment over years, and that patients who start earlier tend to preserve more tissue over the long term. For a condition that would otherwise progress without treatment, this represents a meaningful advance in care.
The most frequently reported side effects in clinical trials were conjunctival hemorrhage (a small, visible area of blood on the white of the eye) and a temporary increase in intraocular pressure (the fluid pressure inside the eye). Both are typical of intravitreal injections in general. Conjunctival hemorrhages are usually painless and resolve on their own within days. Your retina specialist will check your eye pressure at each appointment and address any sustained elevation appropriately.
In clinical trials, approximately 7% of patients receiving monthly Izervay developed neovascularization, meaning new abnormal blood vessels grew in or beneath the retina, compared to 4% in the sham group. This is a known risk associated with complement inhibitor therapy. Your retina specialist will monitor for this at every visit using imaging. If neovascularization is detected, it can be treated, most commonly with anti-VEGF injections. Consistent monitoring is key to catching this complication early and managing it effectively.
Rare but potentially serious risks associated with intravitreal injections include endophthalmitis (a severe infection inside the eye), retinal detachment, and significant sustained increases in intraocular pressure. These complications are uncommon. Long-term safety data from the extension study did not identify any cases of retinal vasculitis or occlusive vasculitis with Izervay.
Seek urgent care immediately if you notice any of the following after an injection:
- Sudden loss of vision
- Severe or quickly worsening eye pain
- A dramatic increase in floaters
- New or sudden flashes of light
- Significant new redness that does not improve
Early treatment of complications consistently leads to better outcomes. When in doubt, contact our office or go directly to an emergency room.
Comparing Your Treatment Options
Understanding how Izervay fits within the broader range of retinal treatments can help you have more informed conversations with your retina specialist and feel more confident in your care plan.
There are currently two FDA-approved complement inhibitors for geographic atrophy. Izervay (avacincaptad pegol) inhibits complement protein C5, which acts near the end of the complement cascade. The other approved option, Syfovre (pegcetacoplan), inhibits complement C3, a protein that acts earlier in the same cascade. Both treatments have been shown in clinical trials to slow the growth of geographic atrophy lesions. Izervay is administered monthly, while Syfovre can be given monthly or every other month. Your retina specialist can review your imaging and help determine which approach may be more appropriate for your specific situation and preferences.
Anti-VEGF medications (including aflibercept, ranibizumab, bevacizumab used off-label, and faricimab) target a protein called vascular endothelial growth factor (VEGF). They are effective for conditions where abnormal blood vessels grow and leak fluid, such as wet AMD, diabetic macular edema, and retinal vein occlusions.
Geographic atrophy involves a fundamentally different process: the immune system actively destroying retinal cells through complement overactivation. Complement inhibitors like Izervay are designed specifically to address this pathway. Anti-VEGF treatments and complement inhibitors are not interchangeable and treat distinct disease processes. Your retina specialist will confirm which treatment class is appropriate based on your diagnosis.
Frequently Asked Questions
The following answers address practical questions that come up often when patients are beginning or considering Izervay. They are meant to add context and decision guidance beyond what is covered in detail elsewhere on this page.
Most patients do not experience a visible improvement in how well they can see after starting Izervay. The treatment is designed to slow the loss of additional retinal tissue, not to rebuild cells that have already been destroyed. Many patients find that their vision stays roughly the same rather than improving. The clearest measure of the treatment's benefit is lesion size on imaging, which your retina specialist will track and review with you over time. For many patients with geographic atrophy, staying the same rather than getting worse is the meaningful goal of treatment.
Geographic atrophy continues to progress between visits regardless of treatment, so missing appointments means the retina goes without protection during that period. If you know you need to reschedule, contact our office as soon as possible to minimize any gap in treatment. Your retina specialist can advise on how to resume after a break and will use imaging to assess your current lesion status before moving forward. Keeping to a consistent monthly schedule gives the treatment its best opportunity to work.
Most everyday activities can be resumed within hours of your appointment. The main precautions in the days following an injection are to avoid rubbing the eye, swimming, hot tubs, and dusty environments, all of which can raise infection risk while the eye heals around the injection site. Screen use, reading, and most other daily activities are generally fine once the numbing drops have worn off and your vision feels clear. If you are unsure about a specific activity, ask your retina specialist before your next appointment.
Because geographic atrophy is a chronic condition with no current cure, ongoing treatment is typically required to maintain the benefit of slowing disease progression. The 2025 FDA label update confirmed that there is no required stopping point for treatment, and extension study data showed continued benefit at 3.5 years of follow-up. That said, treatment decisions are always based on your individual situation and how your condition responds over time. Your retina specialist will review your imaging at each visit and discuss whether continuing treatment remains the right choice for you.
Between scheduled visits, pay close attention to any changes that feel different from your usual baseline. Sudden vision loss, a rapidly appearing dark or blank area, a sharp increase in floaters, new flashes of light, or new distortion in your central vision are all signs that require urgent evaluation. Do not wait for your next scheduled appointment if you experience these symptoms. Contact our office right away or go to an emergency room, because early intervention consistently leads to better outcomes.
Schedule Your Consultation at New England Retina Associates
If you have received a diagnosis of geographic atrophy or have been referred by your eye doctor for an evaluation, we encourage you to reach out to our team at New England Retina Associates. Our fellowship-trained vitreoretinal surgeons bring specialized expertise in retinal disease and access to the most current diagnostic and treatment options available, including both FDA-approved complement inhibitor therapies. We are committed to providing clear, personalized guidance so you feel informed and supported at every stage of your care, and we welcome patients throughout Connecticut at any of our four convenient office locations.
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