At the 2025 European Society of Retina Specialists (Euretina) congress in Paris this week, a group of international retina experts released "Reframe GA," a white paper calling for a fundamental shift in the way geographic atrophy (GA) is defined, diagnosed, and managed.

The paper identifies 4 core challenges: the lack of refined definitions and classifications of GA, limited clinical and regulatory experience with the condition, inadequate functional outcome measures, and the need for earlier referral to specialists. The authors argue that current approaches are insufficient to capture the heterogeneity of the disease and risk slowing the development and adoption of new therapies. “There is no common agreement on how to define what is GA and what is not GA,” noted Nicole Eter, MD, of Münster University Hospital in Germany, a coauthor on the paper. 

Current classifications, based largely on color fundus photography, fail to capture the diversity of GA phenotypes. Imaging advances such as OCT and fundus autofluorescence have revealed structural features—including reticular pseudodrusen, hyperreflective foci, and ellipsoid zone loss—that influence prognosis but remain absent from existing frameworks. “The heterogeneous nature of GA remains a significant challenge for both researchers and clinicians,” observed Jordi Monés, MD, of the Institut de la Màcula in Barcelona, Spain.

The authors also criticized the continued reliance on best-corrected visual acuity (BCVA) as a primary endpoint. Because BCVA often remains preserved until late in disease, it poorly reflects the functional decline patients experience earlier. They recommend developing and validating alternative measures such as low-luminance visual acuity, microperimetry, reading speed, and contrast sensitivity.

Another emphasis is on patient stratification. Subgroups such as those with extrafoveal or multifocal lesions, or those with diffuse-trickling autofluorescence patterns, may progress faster and stand to benefit most from early intervention. “GA is not well defined and is not a uniform disease. We need good patient selection,” said Imadeddin Abu Ishkheidem, MD, of Sahlgrenska University Hospital in Gothenburg, Sweden.

Finally, the authors urged earlier referral of patients with intermediate AMD to retina specialists, to detect GA before foveal involvement. Sobha Sivaprasad, MD, of Moorfields Eye Hospital in London stressed the urgency: “If you see a geographic atrophy just extrafoveally to the center, in 2 years that patient is at risk of losing his or her vision.”

In conclusion, the "Reframe GA"authors contend that a more holistic and forward-looking framework is needed, in which clinicians move beyond tracking atrophy progression and instead adopt strategies that address the broader impact of GA on patients’ visual function and quality of life. This reframing involves several key considerations:

• Expand beyond lesion size: Disease burden is not fully captured by measuring atrophy growth alone. Other functional and structural changes, such as photoreceptor loss outside lesions, should be considered.
• Prioritize functional outcomes: Patient-centered outcomes, including reading speed, contrast sensitivity, and visual independence, should take greater precedence over structural measures.
• Recognize earlier disease impact: Subclinical changes and early functional decline may precede visible lesion enlargement and should inform treatment approaches.
• Adopt a long-term perspective: Given the chronic and progressive nature of GA, care strategies should aim for long-term preservation of function rather than short-term metrics.
• Integrate multimodal imaging and biomarkers: A combination of structural and functional markers will be needed to better guide treatment and monitoring decisions.

The "Reframe GA" initiative was organized and funded by Astellas Pharma, which also provided editorial input to the final report. The white paper can be downloaded here.