Izervay is an FDA-approved eye injection used to treat geographic atrophy, an advanced form of age-related macular degeneration (AMD) that causes permanent vision loss. It works by slowing the growth of damaged areas in the retina, helping preserve the vision you still have. It was one of the first treatments ever approved for this condition, which previously had no effective therapy.
What Geographic Atrophy Is
Geographic atrophy is the late stage of “dry” AMD, the more common form of age-related macular degeneration. Over time, cells in the macula (the central part of the retina responsible for sharp, detailed vision) break down and die, leaving patches of damage that slowly expand. As these patches grow, you lose central vision: faces become harder to recognize, reading gets difficult, and fine details blur or disappear entirely. The damage is irreversible, and the patches only grow larger without intervention.
For decades, there was no approved treatment for geographic atrophy. Doctors could only monitor the progression. Izervay, approved in 2023, changed that by offering a way to slow the rate at which those damaged patches expand.
How Izervay Works
The retinal damage in geographic atrophy is driven partly by an overactive immune process called the complement system. Normally, complement proteins help your body fight infections, but in geographic atrophy, this system attacks healthy retinal cells. One protein in particular, called C5, plays a central role. When C5 gets activated, it splits into fragments that trigger inflammation and form a destructive structure on cell surfaces.
Izervay is a specially designed molecule that binds to C5 and blocks it from splitting apart. By doing this, it prevents both the inflammatory signal and the cell-damaging structure from forming. The result is less ongoing destruction of retinal tissue, which translates to slower expansion of the damaged patches in your macula.
How Well It Works
In the GATHER2 clinical trial, published in The Lancet, patients who received monthly Izervay injections for 12 months had 14% slower growth of their geographic atrophy lesions compared to patients who received a sham (placebo) injection. That may sound modest, but geographic atrophy is a progressive, lifelong condition. Slowing the rate of damage accumulation year after year can meaningfully delay the point at which central vision becomes severely impaired.
It’s important to understand what Izervay does not do. It does not restore vision that has already been lost, shrink existing patches of damage, or stop progression entirely. It slows the pace of worsening. For a condition that previously had zero treatment options, that represents a significant shift in what’s possible.
What Treatment Looks Like
Izervay is given as an injection directly into the eye, once a month, for up to 12 months. Each injection delivers a small volume of fluid (0.1 mL) into the gel-like interior of the eye. If both eyes are affected, each eye receives its own injection.
The procedure itself is performed in your eye doctor’s office. Your eye is numbed with anesthetic drops beforehand, so most people feel pressure rather than sharp pain. The injection takes only seconds. You’ll typically spend some time in the office afterward so your doctor can check for any immediate complications, like changes in eye pressure. Plan on monthly visits for the duration of treatment, roughly every four weeks.
Common Side Effects
Because the drug is injected into the eye, the most common side effects are eye-related. Pooled data from clinical trials showed the following rates over 12 months in patients receiving Izervay:
- Conjunctival hemorrhage (a red spot on the white of the eye from the injection): 13%, compared to 9% with sham
- Increased eye pressure: 9%, compared to 1% with sham
- Blurred vision: 8%
- New abnormal blood vessel growth (neovascular AMD): 7%
- Eye pain: 4%
The conjunctival hemorrhage is typically a cosmetic issue, a small bruise-like red patch on the surface of the eye that resolves on its own. The increase in eye pressure is something your doctor will monitor at each visit, since sustained high pressure can damage the optic nerve over time.
The development of neovascular AMD (the “wet” form of macular degeneration) in 7% of patients is a more serious concern. Wet AMD involves abnormal blood vessels leaking fluid into the retina and requires its own separate treatment with different injections. Your doctor will watch for signs of this at every appointment. Over 24 months, the rate of conjunctival hemorrhage rose to 17% and increased eye pressure to 13%, reflecting the cumulative effect of repeated injections.
How Izervay Compares to Syfovre
Izervay is one of two FDA-approved treatments for geographic atrophy. The other is Syfovre (pegcetacoplan), which was approved slightly earlier in 2023. Both are eye injections that target the complement system, and both slow the growth of geographic atrophy lesions. The key difference is where in the complement chain they act: Syfovre targets an earlier protein called C3, while Izervay targets C5 further downstream.
Syfovre can be given either monthly or every other month, while Izervay is given monthly. Both require ongoing office visits for the duration of treatment. In practice, the choice between the two often comes down to your doctor’s assessment of your specific situation, side effect profiles, and practical considerations like scheduling. Neither drug has been tested head-to-head against the other in a clinical trial, so there’s no direct comparison of which works better.
Who Izervay Is For
Izervay is specifically approved for adults with geographic atrophy secondary to age-related macular degeneration. It is not used for early or intermediate dry AMD, and it is not a treatment for wet AMD. If you have geographic atrophy in one or both eyes and are still losing vision progressively, you may be a candidate.
The treatment is not appropriate if you have an active eye infection or significant inflammation in or around the eye. Your retina specialist will evaluate your eyes before starting treatment to confirm the diagnosis and rule out any conditions that would make injections unsafe. Because geographic atrophy is a chronic condition, committing to monthly injections for up to a year is a real consideration, and worth discussing with your doctor in terms of what to realistically expect from treatment.