Purpose <p>To characterize visual difficulties associated with geographic atrophy (GA).</p> Methods <p>A prospective study included 91 participants with bilateral GA. A visual activities questionnaire was administered at baseline and annually for 2&#xa0;years along with best-corrected visual acuity (BCVA) and GA size. Baseline questionnaire responses were compared using logistic regressions, and longitudinal changes were analyzed with generalized linear mixed-effect models. A small group of 12 participants with drusen without GA served as a comparison to participants with GA and good VA.</p> Results <p>Compared to drusen participants, bilateral GA participants with BCVA of 20/50 or better reported significantly more difficulties in 8 vision-specific tasks. The frequencies of difficulty in reading small print, trouble with face recognition, and stopping driving were positively associated with GA severity cross-sectionally, measured by either BCVA or GA size, and increased over 2&#xa0;years (<i>P</i> &lt; 0.05 for each). Additional significant longitudinal changes included difficulty seeing in dim light (<i>P</i> = 0.005) and locating a sign (<i>P</i> = 0.008).</p> Conclusion <p>Reading, vision in dim illumination, face recognition, locating signs, and driving worsen over 2&#xa0;years in patients with GA, and may be the appropriate self-reported items to monitor in a clinical trial. These findings highlight the need for therapies addressing both GA enlargement and visual function decline.</p>