New Insights Into EMAP and Its Relationship to AMD

New research raises questions about the classification of extensive macular atrophy with pseudodrusen-like appearance and its potential implications for interpreting geographic atrophy clinical trial results.

By: Alessandro Feo, MD, Patricio G. Schlottmann, MD

Retinal Physician November 11, 2026

Objective:

The article examines the objective, findings, and clinical context described in Rethinking EMAP and Its Relationship to AMD.

Approach:

Format: Edited interview with Alessandro Feo, MD, at the 2026 SARyV Meeting.
Context: The discussion reviews EMAP’s reported features, geographic distribution, proposed relationship to AMD, and potential overlap with diffuse-trickling GA in clinical trials.

Key Findings:

EMAP was first described in 2009 by a French group as a potentially distinct macular dystrophy.
Feo described EMAP’s reported features as vertical macular atrophy, pseudodrusen-like deposits, and negative genetic testing in conjunction.
Citing newer descriptions, including reports from the United States, Feo said EMAP may be a variant or subtype of late atrophic AMD; he pointed to presumed basal laminar deposits as a feature shared with AMD.
Feo cited evidence implicating complement in EMAP pathogenesis and similarities between EMAP and the diffuse-trickling pattern of geographic atrophy.
Feo said anticomplement-therapy trials that included diffuse-trickling GA should be reevaluated because some participants may have had EMAP.

Interpretation:

The interview presents EMAP’s classification as unsettled and raises the possibility that some cases categorized as diffuse-trickling GA in prior trials may represent EMAP.

Limitations:

The transcript does not quantify how often EMAP may have been included among diffuse-trickling GA cases or assess how reclassification would affect trial results.

Conclusion:

Feo argued that EMAP may be a subtype of late atrophic AMD and that its possible inclusion among diffuse-trickling GA cases warrants reassessment of relevant anticomplement trial results.