Geographic Atrophy (GA) - Prevent Blindness (2022)

Geographic Atrophy (GA) - Prevent Blindness (1)

Eye Diseases & Conditions

Geographic atrophy (GA) is an advanced form of dry age-related macular degeneration (commonly referred to as AMD). AMD is a disease that affects part of the back of the eye called the macula. The macula is the central part of the retina, which is the “film” lining the inside of the eye. Some patients with AMD will develop GA, an advanced form of the dry type of AMD. In GA, areas of the retina experience cell death (atrophy). These areas can grow and may result in a dim or blind spot in your vision. GA often first develops near the fovea, the center of the macula, which is the central and clearest part of your vision. Since the most center part of vision may not be affected at first, this may allow some with GA to keep a small area of central vision leading to possible delays in diagnosis of GA. GA can lead to progressive and permanent vision loss. If you have GA in one eye, you are more likely to develop it in the other eye. It is estimated that 1 million people in the United States have GA.

Download the Geographic Atrophy (GA) Fact Sheet

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Geographic Atrophy (GA) - Prevent Blindness (3)

Dry AMD: The most common form of AMD is dry AMD. This is caused by small yellow deposits called drusen, which form under the retina. They can grow in size and stop the flow of nutrients to the retina. This will cause the retinal cells in the macula to die, causing vision to become blurred. This form of the disease usually worsens more slowly than wet AMD.
Wet AMD generally causes more rapid and, in some cases, more serious vision loss. The vision loss is linked to bleeding (hence the term “wet”). In wet AMD, tiny new blood vessels grow under and into the retina. These blood vessels often break and leak, causing fluid build-up under the retina which leads to loss of vision.

Geographic Atrophy (GA) - Prevent Blindness (4) Geographic Atrophy (GA) - Prevent Blindness (5)

Normal Vision and Geographic Atrophy

What increases your risk for geographic atrophy?

While the cause of GA is unknown, the following can increase your risk for GA:

  • Family history of AMD
  • Age – over 60 years old
  • Race – Caucasians have a higher rate of AMD
  • Light colored eyes
  • Smoking
  • Genetics
  • Heart disease
  • Diabetes
  • Women not using menopausal hormone replacement therapy
  • High blood pressure (hypertension)
  • High cholesterol
  • Obesity
  • High sun exposure throughout the life span
  • Poor diet with a low intake of fruits and vegetables (specifically dark green leafy vegetables)

What symptoms could you have with geographic atrophy?

There may be no symptoms in the early stages until the disease progresses or affects both eyes. Vision changes due to GA may include:

  • Difficulty seeing in the center of your vision, which is needed for reading, crafts, cooking, recognizing faces, and driving
  • Numbers or letters disappearing or missing when reading
  • A dim or dark spot in your central or near central (side) vision
  • Trouble seeing in dim light
  • Needing extra light to read
  • Dull or washed out colors
  • Vision not as clear or sharp

If you experience any of these symptoms, see an eye doctor as soon as possible.

How is geographic atrophy diagnosed?

If you are 50 years old or older, you should get a complete eye exam every one or two years or as indicated by your eye doctor. It is important to attend all scheduled eye exams even if you have no noticeable vision problems.

During the eye exam, the eye doctor will conduct the following tests, among others:

  • Visual acuity: This test will find out how well you can see through your central vision in each eye. This is the part of the exam when you read an eye chart to see how clearly you see.
  • Dilated eye examination: The eye doctor will dilate (widen) the pupils of the eyes with eye drops to allow a better view of the back of your eyes (retina and macula). The doctor will look for changes in the macula.

If your eye doctor suspects or is monitoring you for GA, then the following tests may be conducted:

  • Fundus photograph: A fundus photograph provides a picture of the retina and may document the amount of drusen or GA to compare at future visits.
    Sometimes the photograph will be taken with special imaging called autofluorescence, which may help with the identification of GA.
  • Optical coherence tomography (OCT): The OCT examination provides a cross sectional image of the eye, which can show if the macula is thickened, a loss of tissue, and/or if there is fluid under the retina that may be affecting vision.
  • Fluorescein angiography: During this test, a dye is injected into the arm that “lights up” the blood vessels in the eye while multiple photos are taken of the back of the eye. These images might show if there are new blood vessels in the macula and/or if there is leaking of dye (to show there is fluid into or beneath the
    retina). This is sometimes used for GA but more often for wet AMD.
  • Visual function tests: Your eye doctor may use additional tests will help to assess your visual impairment.

How is geographic atrophy treated?

There are no treatments available for GA right now. But there are some medical and surgical treatments in clinical trials now. Learn more about clinical trials.

What can you do if you have or are at risk for geographic atrophy?

If you have or are at risk for GA, here are some things you can do:

  • Amsler grid: This test helps detect problems in your central vision. It is important to perform this test on each eye every day. An amsler grid is made of straight horizontal and vertical lines. If you notice any changes such as having trouble reading, or seeing straight lines that appear wavy or broken, tell your eye
    doctor right away. Download and print an Amsler grid
  • Home monitoring: Other home monitoring devices or programs may be provided by your eye doctor to monitor progression of AMD.
  • Eye exams: It is important that you get an eye exam as often as it has been recommended by your eye doctor. The exam will determine if you have AMD and if your condition is worsening.
  • Healthy habits can lead to healthy eyes – quit smoking, eat healthy with lots of fruits and vegetables, especially dark green leafy vegetables, wear sunglasses, and stay active (remember to talk to a doctor before starting an exercise program).
  • Vitamins: Your eye doctor may ask you to take AREDS vitamins to lower the risk of dry AMD becoming wet AMD. Talk with your health care provider and eye care professional before taking any vitamins. Keep in mind, these vitamins do not cure AMD.

Geographic Atrophy (GA) - Prevent Blindness (6)

Is there anything you can do if you lost vision to geographic atrophy?

If you or someone you know has lost some sight due to GA or other forms of AMD, low vision rehabilitation with a low vision specialist can help you continue to live independently by maximizing the use of the vision you still have. Vision rehabilitation can provide strategies and skills along with low vision aids for living with low vision. A low vision specialist will help determine the right plan based on your needs. Ask your eye doctor to recommend a low vision specialist.

Low vision aids can include:

  • Magnifying devices for reading
  • Telescopic lenses for distance
  • Specialized lighting and lights
  • Large-print newspapers, magazines and books
  • Closed-circuit TVs that magnify a printed page on screen
  • Special computers and tablets
  • Special software added to your current computer or tablet

Visit these support resources if you have lost some sight to GA:

Living Well with Low Vision

Living Well with Low Vision is an online resource to educate those
with loss of vision on how to their independence and quality of life.

A.S.P.E.C.T. Patient Empowerment Program

Prevent Blindness developed the A.S.P.E.C.T. Program– Advocacy, Support, Perspective, Empowerment, Communication, and Training– to engage individuals in their eye health through storytelling and advocacy in a virtual group setting. The program aims to equip participants with knowledge, skills, and confidence to become advocates for vision and eye health – at the individual, peer-to-peer, community, state, or national level.

How does geographic atrophy affect mental health?

GA can cause loss of vision. For some, loss of vision can lead to feelings of depression, anxiety, and loss of independence. Not everyone who has vision loss will experience depression or anxiety. Some individuals may notice a change in their desire to socialize with others, or increased frustration with the additional time it may take to accomplish tasks of daily living. If you do experience any of these symptoms, know there is help available.

To help support your mental health as you deal with GA:

Talk to your primary care doctor, mental health professional, or eye doctor: Talk to your doctor about any changes to your emotional well-being. Ask your eye doctor questions on how GA will affect your daily life and work. Seek assistance on how to deal with the changes in your life due to GA.

Seek support: Look for support groups of others who are going through GA. MD Support provides a list of support groups near you on their website. These groups can help you learn about your condition, share your experience, and find support.

Connect with others and the things that bring you joy: Stay connected with friends and family to keep you from feeling isolated. Over time, you can find new ways to do the things you love or to discover new hobbies that bring you happiness.

Exercise can help symptoms of depression or anxiety and make you feel better. Talk to your health care professional to determine what exercise routine may work best for you, especially if you have changes to your vision due to GA.

Seek vision rehabilitation: Ask your eye doctor to recommend a low vision specialist. The specialist can help to maximize the use of the vision you have.

To learn more about your mental health as you deal with GA, check out the following resources:

Vision Loss and Mental Health

Centers for Disease Control and Prevention (CDC): The Mental Health of People with Disabilities

American Psychological Association: Depression

National Alliance on Mental Illness (NAMI): Signs and Symptoms

Additional resources

GuideMe Resource for Agerelated Macular Degeneration

GuideMe is a resource for those who have been recently diagnosed with AMD, their family members and caregivers.

AMD Central

AMD Central is an online resource that curates trusted information and support tools from leading patient advocacy organizations in one, convenient, accessible destination to help people with AMD live their best lives.

If you are at risk for or living with GA, know there is support and are resources to help you. The information and resources shared above can guide you through your journey.

FAQs

Can you prevent blindness from macular degeneration? ›

The key to slowing or preventing vision loss from dry AMD is regular eye exams. People age 50 or older should get a complete eye exam and follow-up with eye exams every one or two years or as indicated by the eye doctor. It is important to attend all scheduled eye exams even if there are no noticeable vision problems.

How can I protect my eyes from macular degeneration? ›

Protect your eyes from the sun by wearing sunglasses and broad-brimmed hats. Research also suggests that certain nutrients help prevent macular degeneration. Eat a diet rich in fresh fruits and dark-green leafy vegetables, such as spinach, collard greens, and kale.

Does macular degeneration always cause blindness? ›

Macular degeneration doesn't affect side (peripheral) vision, so it rarely causes total blindness.

Is there a cure for geographic atrophy? ›

Recent findings: There are currently no treatments for GA, a form of advanced AMD that causes significant visual morbidity. Currently, therapeutic candidates are being developed to delay further progression of GA or even attempt to reverse some of the damage.

How long does it take for macular degeneration to cause blindness? ›

How Long Does it Take to Lose Vision with Macular Degeneration? In late stages of AMD, you may have difficulty seeing clearly. On average, it takes about 10 years to move from diagnosis to legal blindness, but there are some forms of macular degeneration that can cause sight loss in just days.

Can you stop macular degeneration from progressing? ›

As of now, there's no treatment for dry macular degeneration. However, there are many clinical trials in progress. If your condition is diagnosed early, you can take steps to help slow its progression, such as taking vitamin supplements, eating healthfully and not smoking.

How do you prevent macular degeneration from getting worse? ›

Eating a diet high in omega-3 fatty acids, low in saturated fats and cholesterol, low in refined sugar or processed carbohydrates, and high in specific vitamins and minerals not only improves your overall health but can reduce the risk and help slow the progression of AMD.

What is the best vitamin for macular degeneration? ›

Vitamins A, C, and E are the most effective vitamins for reducing the risk of macular degeneration [13]. However, only vitamin A plays an essential role in the human retinal pigment epithelial cells, whereas vitamins C and E are known to act as antioxidants.

Does wearing dark glasses help macular degeneration? ›

Often people equate a darker lens with better protection but darker does not mean better and in fact can mean less visibility, especially for those with macular degeneration. The darker the lens the harder it is to see clearly. The reduced light makes it harder to navigate and to distinguish details.

What percentage of AMD patients go blind? ›

Wet (exudative) AMD: accounts for 10% of AMD but results in 90% of blindness. Severe rapid visual loss occurs.

How fast does AMD progress? ›

It usually progresses slowly over several years. There's no treatment for late dry AMD, but you can find ways to make the most of your remaining vision. And if you have late dry AMD in only 1 eye, you can take steps to protect your other eye.

What is the newest treatment for macular degeneration? ›

On October 22, 2021, the FDA approved Susvimo (ranibizumab injection) 100 mg/mL for intravitreal use via ocular implant for the treatment of people with wet, or neovascular, age-related macular degeneration (AMD) who have previously responded to at least two anti-vascular endothelial growth factor (VEGF) injections.

What does a person with geographic atrophy see? ›

Although it begins slowly, geographic atrophy is a progressive and irreversible disease that leads to central scotomas. A person with geographic atrophy will see a central scotoma, a blind spot directly in their center of vision.

How does geographic atrophy affect vision? ›

Geographic atrophy is a chronic progressive degeneration of the macula and can be seen as part of late-stage age-related macular degeneration (AMD). The condition leads to central scotomas and permanent loss of visual acuity.

Is geographic atrophy the same as dry AMD? ›

Geographic atrophy (GA) is an advanced form of dry age-related macular degeneration (commonly referred to as AMD). AMD is a disease that affects part of the back of the eye called the macula. The macula is the central part of the retina, which is the “film” lining the inside of the eye.

What foods should you avoid with macular degeneration? ›

Foods to avoid with macular degeneration
  • Processed foods that contain trans fats.
  • Tropical oils, like palm oil (use vitamin E–rich safflower and corn oil instead)
  • Lard and vegetable shortening, and margarine.
  • High-fat dairy foods (eggs in moderation are a good source of eye-healthy nutrients)
  • Fatty beef, pork and lamb.

Do vitamins help with macular degeneration? ›

The National Eye Institute conducted the Age-Related Eye Disease Studies (AREDS and AREDS2) to investigate and evaluate the effects of vitamins on the progression of macular degeneration and other eye conditions. Evidence indicates that dietary supplementation with antioxidant vitamins and zinc may be beneficial.

At what age does macular degeneration usually begin? ›

Age-related macular degeneration usually begins at age 55 or older. There is a very low risk of progression from the early stage to the late stage of AMD (which involves vision loss) within five years after diagnosis.

How do I strengthen my macula? ›

Ways to prevent age-related macular degeneration:
  1. Quit smoking. “Rules 1, 2 and 3 are stop smoking,” says Rosenthal. ...
  2. Know your family history. ...
  3. Eat leafy greens. ...
  4. Take supplements. ...
  5. Wear sunglasses. ...
  6. Maintain a healthy blood pressure and weight. ...
  7. Test yourself with an Amsler grid.
23 Jan 2019

What foods heal your macula? ›

Leafy green vegetables:

Brimming with vitamin C, calcium, beta-carotene, and the carotenoids lutein and zeaxanthin. Studies have shown that eating foods rich in lutein and zeaxanthin like spinach, kale, and collard greens, can increase the pigment density in the macula and lower the risk of AMD.

What aggravates macular degeneration? ›

AMD can result in severe loss of central vision, but people rarely go blind from it. Risk factors for AMD include being 50 and older, smoking, having high blood pressure and eating a diet high in saturated fat.

Can lack of sleep cause macular degeneration? ›

A population-based cohort study identified that patients with insomnia developed AMD at a rate 0.7% higher than those who did not. Not sleeping can lead to more than just tired eyes—insomnia has been identified as an objective sign of an increased risk of developing age-related macular degeneration (AMD).

Can stress cause macular degeneration? ›

Age-related macular degeneration (AMD), the leading cause of vision loss among older adults in the United States, is often associated with psychological stress.

Can laser eye surgery fix macular degeneration? ›

Laser photocoagulation is a type of laser surgery for the eyes. It is done to treat age-related macular degeneration (AMD). AMD is a condition that can lead to loss of vision.

Is Turmeric Good for macular degeneration? ›

Consider sprinkling on some turmeric, a spice used in curry recipes, for antioxidant properties that are currently being studied by researchers funded by AHAF, all these foods may help prevent macular degeneration.

Does sleep help macular degeneration? ›

Too much sleep may be tied to retinal problems, a new study suggests. Adult patients of a retina practice with a diagnosis of geographic atrophy secondary to age-related macular degeneration (AMD) were significantly more likely than those without the condition to report sleeping more than 8 hours per night.

Is zinc Good for macular degeneration? ›

Antioxidant Vitamins and Zinc Reduce Risk of Vision Loss from Age-Related Macular Degeneration | National Eye Institute.

Is Omega 3 good for macular degeneration? ›

Dec. 1, 2010 -- New research indicates that diets rich in omega-3 fatty acids from fish and shellfish may be good for the eyes of older Americans, offering protection against age-related macular degeneration, a common cause of blindness in the U.S.

Can you still drive if you have macular degeneration in one eye? ›

Can I Still Drive If I Have Macular Degeneration? Many patients with vision loss due to AMD can continue to drive with the help of low vision aids. Whether this is possible for you depends on many factors, such as the severity of your vision loss and the local DMV driving laws in your region.

How much do glasses cost for macular degeneration? ›

According to review sites and eyewear brands, the cost of specialized glasses may range anywhere from $200–10,000. The American Macular Degeneration Foundation provides a list of contacts for people seeking vision aids.

Do eye injections work for macular degeneration? ›

Successful treatment can preserve vision and, in some cases, actually improve vision over time. In the modern era, eye injections have proven to be very helpful in the treatment of wet macular degeneration.

What are the chances of getting macular degeneration in both eyes? ›

The vision loss from dry AMD happens slowly and usually is not as severe as that from wet AMD. But dry AMD can sometimes turn into the wet form. Up to 5% of people who have dry AMD in both eyes will get wet AMD in a year, while 13% to 18% will get it in 3 years.

How many wet AMD patients are there? ›

Prevalence of AMD

About 200,000 new cases of wet AMD are diagnosed each year in North America.

Does early AMD always progress? ›

Not everyone with early AMD will develop advanced AMD, and those who develop an advanced form of the disease do not develop total blindness.

What are the stages of AMD? ›

There are three stages:
  • Early-stage AMD: Medium-sized drusen deposits and no pigment changes, no loss of vision.
  • Intermediate AMD: Large drusen and/or pigment changes. There may be mild vision loss, but most people don't experience any problems.
  • Late-stage AMD: Dry or wet macular degeneration that causes vision loss.
22 May 2006

Can you live with macular degeneration? ›

There are millions of people who suffer with macular degeneration. The good news is, millions of them continue living their life and continue doing what they always did.

How can I fix macular degeneration naturally? ›

What Are Some Natural or Home Remedies to Treat AMD?
  1. Avoid beta carotene.
  2. Eat more vegetables, especially leafy greens.
  3. Reduce sugar intake significantly.
  4. Consume more omega-3 fatty acid foods, like fish.
  5. Eat more fruit, especially high-fiber fruit.
11 Nov 2021

What is the best eye injection for macular degeneration? ›

Currently, the most common and effective clinical treatment for Advanced Wet Age-Related Macular Degeneration is anti-VEGF therapy – which is periodic intravitreal (into the eye) injection of a chemical called an “anti-VEGF”.

Is there an alternative to injections for macular degeneration? ›

Vabysmo will be available this year to patients with both wet macular degeneration and diabetic retinopathy. Other attempts at extending injection intervals have been unsuccessful, include retinal laser, focal radiation, eye drops, and oral medication.

How common is geographic atrophy? ›

More than 5 million people worldwide have geographic atrophy, 2 including nearly 1 million people in the U.S. In developed nations, approximately 1 in 29 people over age 75 have geographic atrophy, 3,4,5 which increases to nearly 1 in 4 people over age 90.

What does geographic atrophy look like on Oct? ›

In high resolution OCT the atrophic area shows hyperreflective clumps at different levels, segmented plaques of the outer band and elevations with variable reflectivity(41).. In the perilesional area there are elevations of the outer retinal layers, as well as thickening of outer hyperreflective band.

Can you get shots in your eyes? ›

People often take steroids as injections or eye drops — or your doctor can put a special device called an implant in your eye. The implant gives you constant small doses of the medicine over time. If you get the implant, you may be able to stop getting monthly steroid injections.

Is there a cure for geographic atrophy? ›

Recent findings: There are currently no treatments for GA, a form of advanced AMD that causes significant visual morbidity. Currently, therapeutic candidates are being developed to delay further progression of GA or even attempt to reverse some of the damage.

What proportion of people with dry AMD develop geographic atrophy? ›

This increases to 4.8% in people aged 65 years or over, and 12.2% in people aged 80 years or over. The same study found the prevalence of geographic atrophy to be 1.3 to 6.7%, and the prevalence of neovascular AMD to be 1.2 to 6.3%.

What is dry AMD progression? ›

Dry AMD is a slow deterioration of the cells of the macula, often over many years, as the retinal cells die off and are not renewed. The term 'dry' does not mean the person has dry eyes, just that the condition is not wet AMD. The progression of dry AMD varies, but people often carry on as normal for some time.

What causes retinal atrophy in humans? ›

The retinal tissue that becomes atrophied may be due to any one of many rare disorders, however retinitis pigmentosa is the most common type. The cause of retinal atrophy is often because of defective genes.

What's the difference between wet and dry AMD? ›

With wet AMD, the function of the macula is impeded by the growth and leakage of abnormal blood vessels beneath the retina. Dry AMD is the result of aging and the thinning of the macula over time. These divergent causes result in different treatments and prognoses for the two types of retinal disorder.

What does atrophic mean? ›

atrophy, decrease in size of a body part, cell, organ, or other tissue. The term implies that the atrophied part was of a size normal for the individual, considering age and circumstance, prior to the diminution.

How can I fix macular degeneration naturally? ›

What Are Some Natural or Home Remedies to Treat AMD?
  1. Avoid beta carotene.
  2. Eat more vegetables, especially leafy greens.
  3. Reduce sugar intake significantly.
  4. Consume more omega-3 fatty acid foods, like fish.
  5. Eat more fruit, especially high-fiber fruit.
11 Nov 2021

At what age does macular degeneration usually begin? ›

Age-related macular degeneration usually begins at age 55 or older. There is a very low risk of progression from the early stage to the late stage of AMD (which involves vision loss) within five years after diagnosis.

Do eye vitamins prevent macular degeneration? ›

Vitamins A, C, and E are the most effective vitamins for reducing the risk of macular degeneration [13].

Who is most at risk for macular degeneration? ›

This disease is most common in people over 60. Family history and genetics. This disease has a hereditary component. Researchers have identified several genes that are related to developing the condition.

How do you prevent macular degeneration from getting worse? ›

Eating a diet high in omega-3 fatty acids, low in saturated fats and cholesterol, low in refined sugar or processed carbohydrates, and high in specific vitamins and minerals not only improves your overall health but can reduce the risk and help slow the progression of AMD.

Can exercise reverse macular degeneration? ›

A new study suggests that regular exercise can reduce the risk of age-related macular degenerationmacular degeneration (AMD) by up to 70%.

How do I strengthen my macula? ›

Ways to prevent age-related macular degeneration:
  1. Quit smoking. “Rules 1, 2 and 3 are stop smoking,” says Rosenthal. ...
  2. Know your family history. ...
  3. Eat leafy greens. ...
  4. Take supplements. ...
  5. Wear sunglasses. ...
  6. Maintain a healthy blood pressure and weight. ...
  7. Test yourself with an Amsler grid.
23 Jan 2019

What causes geographic atrophy? ›

The most pronounced risk factor is increasing age and family history of AMD. Smoking history increases the risk of GA significantly. Both active smokers, but also former smokers are at greater risk of developing geographic atrophy.

What is the best vitamin to take for macular degeneration? ›

These xanthophylls have been demonstrated to improve eye health and lower the risk of a number of eye-related problems. The best vitamins for lowering the risk of macular degeneration are vitamins A, C, and E.

Do reading glasses help macular degeneration? ›

Low vision magnifying reading glasses are also recommended for macular degeneration patient to help enhance their vision for reading print. The glasses will magnify the fonts and make it easier for the patient to read.

What is the newest treatment for macular degeneration? ›

On October 22, 2021, the FDA approved Susvimo (ranibizumab injection) 100 mg/mL for intravitreal use via ocular implant for the treatment of people with wet, or neovascular, age-related macular degeneration (AMD) who have previously responded to at least two anti-vascular endothelial growth factor (VEGF) injections.

Is Turmeric Good for macular degeneration? ›

Consider sprinkling on some turmeric, a spice used in curry recipes, for antioxidant properties that are currently being studied by researchers funded by AHAF, all these foods may help prevent macular degeneration.

What foods should you avoid with macular degeneration? ›

Foods to avoid with macular degeneration
  • Processed foods that contain trans fats.
  • Tropical oils, like palm oil (use vitamin E–rich safflower and corn oil instead)
  • Lard and vegetable shortening, and margarine.
  • High-fat dairy foods (eggs in moderation are a good source of eye-healthy nutrients)
  • Fatty beef, pork and lamb.

What are early warning signs of macular degeneration? ›

The first sign you may notice is a gradual or sudden change in the quality of your vision or that straight lines appear distorted to you. This may gradually turn into a dramatic loss of your central vision. Other symptoms include: Dark, blurry areas or whiteout that appears in the center of your vision.

Does stress cause macular degeneration? ›

Age-related macular degeneration (AMD), the leading cause of vision loss among older adults in the United States, is often associated with psychological stress.

What drugs cause macular degeneration? ›

Various agents can cause cystoid macular edema including topical epinephrine, nicotinic acid, topical prostaglandin analogs (e.g., latanoprost), antimicrotubule agents (paclitaxel, docetaxel), fingolimod, imatinib, glitazones (rosiglitazone, pioglitazone), and trastuzumab.

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