Geographic Atrophy Progression in Eyes with Age-Related Macular Degeneration: Role of Fundus Autofluorescence Patterns, Fellow Eye and Baseline Atrophy Area

Abstract

Background/Objective: To evaluate if fundus autofluorescence (FAF) patterns around geographic atrophy (GA) and the status of the fellow eye have an impact on GA progression. Methods: We included 54 eyes of 35 patients with GA. Areas of GA were quantified by RegionFinder software. Results: GA progression rates in eyes with a diffuse trickling pattern (median 1.42 mm²/year) were significantly higher than in normal eyes (median 0.22 mm²/year) and eyes with other diffuse FAF patterns (median 0.46 mm²/year). Eyes with a banded pattern had a significantly higher progression rate (median 0.81 mm²/year) than those without any FAF abnormalities (p = 0.038). The group with baseline total atrophy of the eyes <1 disk area (DA; median 0.42 mm²) had an inverse relation with GA progression compared to the groups with baseline atrophy >1 DA (p < 0.05). Conclusion: Diffuse trickling and banded patterns may have an impact on GA progression and may serve as prognostic factors.

Prognostic implications of imaging in atrophic macular degeneration and its use in clinical practice and clinical trial design

“…48 The progression rate associated with the 'diffuse trickling' phenotype was also found to be statistically significantly higher when compared to 'other diffuse' patterns in several other studies. 49,50 Fleckenstein et al measured the median GA enlargement rate of the 'diffuse trickling' phenotype to be 2.90 mm 2 /year, 50 closely aligning with the findings of Holz et al 30 Batioglu et al, however, showed a progression rate in the 'diffuse trickling' phenotype of 1.42 mm 2 /year, higher than 'other diffuse' FAF patterns which were associated with a rate of 0.46 mm 2 / year. 49 Although showing the same pattern of prognostic information, this study's considerably slower progression rate may highlight the difficulties in ascertaining the qualitative subtleties of atrophy and between FAF phenotypes.…”

“…The ‘patchy’ phenotype was associated with a faster progression rate than ‘focal’ but slower than both the ‘banded’ and ‘diffuse’ phenotypes . The progression rate associated with the ‘diffuse trickling’ phenotype was also found to be statistically significantly higher when compared to ‘other diffuse’ patterns in several other studies . Fleckenstein et al .…”

“…With 86 patients (86 eyes) and a follow‐up of one year, Jeong et al . also did not mention any transition between phenotype, and there were no transitions stated in a study of 35 patients (54 eyes) with a median follow‐up of 18 months by Batioglu et al . So whilst Biarnes et al .…”

“…74 GPS, fine granular with peripheral punctate spots; FAF, fundus autofluorescence; RPE, retinal pigment epithelium. 43 Holz et al 30 Batioglu et al 49 Fleckenstein et al 50 Jeong et al 48 classification with FAF imaging, FAF patterns have been shown to be more consistently interpreted with cSLO rather than mFC, probably because of its better signal-to-noise ratio. 29 Whilst a high intraobserver agreement was noted for FAF pattern classification, possibly deriving from a set of analytical criteria held by each individual observer, interobserver agreement ranged widely from poor to substantial.…”

Analysing the Progression Rates of Macular Lesions with Autofluorescence Imaging Modes in Dry Age-Related Macular Degeneration

“…Among measurements taken from FAF images, high-risk factors with an impact on disease progression include rapid atrophy enlargement in patients with geographic atrophy; rapid atrophy enlargement in the fellow eye; large initial atrophy size; an area of increased fluorescence surrounding the geographic atrophy; and fluorescence pattern surrounding the area of atrophy. 9,10 …”