There has been much innovation in the retina space since the second half of the 20^th century when Robert Machemer, Charles Schepens, and other illustrious innovators set out to revolutionize the surgical management of retinal conditions. A second revolution began in 2004, this time in medical retina, with the sequential approvals by the US Food and Drug Administration (FDA) of anti-vascular endothelial growth factor (VEGF) agents. For the first time in history, anti-VEGF treatments gave patients with exudative or vascular conditions meaningful visual acuity improvements. Vision restoration strategies through the development of retinal prosthesis and gene therapy, complemented by advanced imaging, have followed suit.

Despite these remarkable recent advances in our field, a large proportion of the world’s increasing aging population remains affected by a common and irreversible retinal disease currently without any FDA-approved therapeutic options: nonexudative age-related macular degeneration (AMD). The entire retina community has been unified and challenged by the need to identify treatments for geographic atrophy (GA). Finally, during the past decade, we have seen exciting results from the first successful large clinical programs. Currently, a true explosion of the therapeutic pipeline for GA is under way, giving patients and medical professionals hope that we may be standing at the brink of a major change in the standard of care for afflicted patients.

This special edition of Retinal Physician, which is supported by Apellis Pharmaceuticals, addresses a number of topics of central importance in the management of patients with GA. The profound effects of the disease on the activities of daily lives of patients as well as the impact of their experiences on retina practices are highlighted in an article of this issue.

Another feature in this issue describes the various imaging modalities at our disposal for the diagnosis, monitoring, and prediction of future change in GA. The definition of GA and precursor lesions on retinal images, as well as lesion location relative to the fovea, are all important considerations in the evaluation of patients with nonexudative AMD. One of the articles in this special edition aims to dispel confusion on the terminology used in this area, and another discusses the effect of lesion location on the results from recent clinical trials.

The most advanced clinical programs for GA are those testing complement inhibition, with trials of pegcetacoplan and avacincaptad pegol leading the way. This issue also offers a feature dedicated to clinical trials on this mechanism of action, and another to other novel targets and promising technologies (antioxidant and anti-inflammatory agents, inflammasome inhibitors, optogenetics, gene therapy, and others).

Future treatment paradigms for GA will impact clinical referrals, imaging, and operational aspects of retina practices. A feature in this issue discusses the necessary preparations as well as compliance considerations and importance of patient education.

Together, the goal of these articles is to familiarize retina specialists with the current imaging modalities for GA, the most advanced therapeutic programs in the pipeline, and the potential impact of approved treatments on future clinical care. We are hopeful that you find them to be informative and valuable for practice. RP

Eleonora Lad, MD, PhD, is an associate professor of ophthalmology and the director of clinical research at Duke Eye Center in Durham, North Carolina. Dr. Lad reports that she is an advisor or consultant to Alexion Pharmaceuticals, Allegro Ophthalmics, Annexon Biosciences, Apellis Pharmaceuticals, EdiGene Bio, Gemini Therapeutics, Iveric Bio, Janssen, LumiThera, NGM Biopharmaceuticals, Nanoscope Therapeutics, Novartis, Retrotope, and Roche; and receives research funding from Apellis Pharmaceuticals, Boehringer Ingelheim, Gemini Therapeutics, Iveric Bio, Janssen, LumiThera, Neurotech Pharmaceuticals, Novartis, and Roche. Reach her at nora.lad@duke.edu.