At the 17th annual Congress on Controversies in Ophthalmology (COPHy), held 20–21 March 2026 in Kraków, Poland, Prof. Sobha Sivaprasad, FRCOphth, took the "no" position in the debate on whether complement inhibition will continue to define the future of geographic atrophy (GA) management. Prof. Sivaprasad—professor of retinal clinical studies at the UCL Institute of Ophthalmology and consultant ophthalmologist at Moorfields Eye Hospital, London, specializing in medical retina—argued that GA is a multistage disease requiring a broader, evolving therapeutic toolkit.

In this Q&A conversation with the Eye Care Network, Prof. Sivaprasad shares her perspective on where complement inhibition fits within that landscape, and what emerging evidence will ultimately guide clinical decision-making.

Note: Transcript edited for clarity and length.

Will complement inhibition remain the mainstay of GA management in the future?

Prof. Sobha Sivaprasad, FRCOphth: GA is not one stage of disease. Therapies such as neuroprotection, mitochondrial rejuvenation, or prevention of apoptosis may help the early stage of GA; while complement therapy, either alone or in combination with earlier strategies, may be useful in the mid-phase of GA progression; and regenerative therapies and visual rehabilitation measures will predominate as options in late stages.

How effective is complement inhibition compared with emerging therapies in slowing disease progression?

Prof. Sivaprasad: As above, we do need to await [the] results of other therapies for GA before we can position complement inhibition in the route to slowing disease progression.

What are the safety, tolerability, and patient adherence considerations for long-term complement inhibition therapy?

Prof. Sivaprasad: So far, the access to available anti-complement therapies is limited around the world. We have no access in the UK or Europe. Reports from the USA are on short-term results. We expect patient adherence to be an issue if treatment has to be delivered at 4-8 weekly intervals.

Could alternative approaches like gene therapy, neuroprotection, or regenerative strategies surpass complement inhibition?

Prof. Sivaprasad: As mentioned earlier, GA is not one focal end point so all these therapies will likely play a role. However, all these therapies need to go through the whole lifecycle of drug development and clinical trials before we can clearly position their role in the management of GA.

As more GA therapies move through trials, what kind of evidence do you think will be most influential in shaping how clinicians adopt and prioritize these treatments in practice?

Prof. Sivaprasad: Real-world evidence of logistics of frequent delivery, patient adherence and long-term outcomes especially 1 to 2 years as we do need to know the outcomes when less numbers of injections are delivered in real-life.

Prof. Sobha Sivaprasad, FRCOphth
E: [email protected]
Prof. Sivaprasad is professor of retinal clinical studies at the UCL Institute of Ophthalmology in London, UK. She is also a consultant ophthalmologist at Moorfields Eye Hospital, London, specializing in medical retina.