Retina and AMD · Late dry AMD
Geographic Atrophy Treatments the first approved options for late dry AMD.
Until 2023 there was nothing to offer patients with geographic atrophy beyond low vision care. Two complement inhibitors are now FDA approved to slow lesion growth. This guide summarizes both labels, the trial results and how a primary care practice identifies and refers candidates.
Quick answer
Slower growth, not restored vision.
Geographic atrophy is the late form of dry AMD. Syfovre (pegcetacoplan) and Izervay (avacincaptad pegol) are complement inhibitors given by intravitreal injection that slowed lesion growth in their phase 3 trials. Neither restores lost vision, and both carry a label warning about new wet AMD, so candidate selection and monitoring matter.
Key takeaways
- Both drugs are intravitreal complement inhibitors given by a qualified physician.
- Syfovre is dosed every 25 to 60 days; Izervay is dosed monthly.
- In February 2025 the Izervay label dropped its limit on how long it can be dosed.
- Trial effects were measured as slower growth of the atrophic lesion.
- Fundus autofluorescence and OCT are the usual tools to document and track GA.
Two approved options side by side.
From each FDA label and the pivotal trial publications.
Syfovre (pegcetacoplan)
15 mg per eye by intravitreal injection once every 25 to 60 days. Binds complement C3 and C3b.
OAKS and DERBY
1,258 patients. Monthly dosing slowed lesion growth 21 percent in OAKS at 12 months; DERBY did not reach significance at 12 months.
Izervay (avacincaptad pegol)
2 mg per eye by intravitreal injection once monthly, about every 28 days.
GATHER2
448 patients. Lesion growth was 14 percent slower than sham at 12 months.
Label warnings
Both labels warn of endophthalmitis, retinal detachment and increased rates of neovascular AMD.
Imaging to document GA
Fundus autofluorescence and OCT show the size and location of atrophy and how it changes.
A referral pathway for GA candidates.
What to capture before the patient leaves.
| Step | What to capture | Why it matters |
|---|---|---|
| Stage the disease | Dilated exam, OCT and autofluorescence images | Shows lesion size and whether the fovea is involved |
| Document function | Best-corrected acuity and reading or low-light complaints | Gives the specialist a functional baseline |
| Discuss expectations | Slower growth, not vision gain, with frequent injections | Patients choosing treatment need to commit to visits |
| Refer | Send images and history to a retina specialist | Treatment decisions and injections happen there |
| Support | AREDS2 formula when indicated, low vision care | Keeps the patient functioning and connected to you |
Many GA patients were told years ago that nothing could be done. Re-examining your dry AMD list and imaging patients with late dry AMD can surface people who now have a treatment conversation to have with a retina specialist.
Frequently asked questions
Do these drugs improve vision?
No. Both were shown to slow the growth of geographic atrophy lesions. They do not restore vision already lost.
Who gives the injections?
Both labels require administration by a qualified physician, which in practice means a retina specialist in most states.
How do the two drugs differ?
Syfovre targets complement C3 and can be given every 25 to 60 days. Izervay is a complement inhibitor dosed monthly.
What are the main risks?
Labels list endophthalmitis, retinal detachment and increased rates of neovascular AMD. Patients should report sudden vision changes immediately.
Is GA the same as wet AMD?
No. GA is the late form of dry AMD, where retinal tissue thins and is lost. Wet AMD involves abnormal blood vessel growth.
What can my practice do without injecting?
Identify and image candidates, refer with full documentation, keep the patient on appropriate nutrition, and provide low vision care.
References
- Apellis. SYFOVRE (pegcetacoplan injection) Prescribing Information. FDA label
- Astellas. IZERVAY (avacincaptad pegol intravitreal solution) Prescribing Information, via DailyMed. DailyMed
- Heier JS, et al. Pegcetacoplan for geographic atrophy (OAKS and DERBY). Lancet. 2023;402:1434-1448. PubMed
- Khanani AM, et al. Avacincaptad pegol in geographic atrophy (GATHER2). Lancet. 2023;402:1449-1458. PubMed
- Optometry Times. FDA approves amended label for Izervay for geographic atrophy. 2025. Optometry Times
- Every source used across these guides is listed on the Vision Rescue sources page.
About this guide
Written for licensed eye care practices by the Vision Rescue team. Questions: providers@visionrescue.com or 1-855-692-8024.
Important notes and disclosures
Information only, not clinical or legal advice. Product names are trademarks of their owners and appear for identification; Vision Rescue does not endorse or review them. Scope of practice, coverage and coding rules vary by state and payer, so confirm locally. Clinical decisions rest with the treating eye doctor.
Find the GA patients already in your records.
Image late dry AMD, refer candidates with complete documentation, and keep their nutrition and low vision care in your practice.