Quantitative multimodal imaging of extensive macular atrophy with pseudodrusen and geographic atrophy with diffuse trickling pattern

Abstract

To compare clinical and imaging characteristics of extensive macular atrophy with pseudodrusen-like appearance (EMAP) versus diffuse-trickling geographic atrophy (DTGA) and non-diffuse-trickling geographic atrophy (nDTGA) phenotypes of age-related macular degeneration. Prospective, observational study performed in the Ophthalmology Department of IRCCS San Raffaele Hospital between January 2015 and January 2021. Patients examination included fundus autofluorescence (FAF) and optical coherence tomography at baseline and follow-up visits. We measured subfoveal choroidal thickness (SCT), Sattler/choroid ratio (SCR), choroidal vascularity index and ellipsoid zone disruption distance on OCT scans. We calculated progression rates and circularity of the atrophic lesions on FAF images. These variables were compared between the three groups and correlations with progression rates and visual acuity were assessed. Sixty-three eyes from 63 patients were included: 18 with EMAP, 18 with DTGA and 27 with nDTGA. Mean follow-up was 3.73 ± 2.12 years. EMAP and DTGA shared a faster progression, lower circularity and SCR, and higher EZ disruption distance than nDTGA, while SCT and CVI were similar between the three groups. Baseline circularity and SCR correlated with progression rates. EMAP and DTGA show similar OCT and FAF characteristics, which differ from nDTGA.

Integrating Machine Learning and Traditional Survival Analysis to Identify Key Predictors of Foveal Involvement in Geographic Atrophy

“…Contrastingly, the diffuse trickling pattern typically linked with SDD and faster lesion growth, 28 did not emerge as a significant risk factor for foveal involvement in our analysis. Characterized by centrifugal expansion, this pattern is distinguished by ring- or horseshoe-shaped configurations around the fovea and persistent hyper-reflective material splitting the RPE/BM complex on OCT. 29 The resulting grayish appearance on FAF imaging could potentially mask the actual extent of GA within the fovea, thereby complicating the assessment of its progression. Finally, SDD are more commonly linked with rod dysfunction and scotopic vision impairment, 30 which may contribute to the observed foveal sparing despite the presence of diffuse trickling FAF and SDD.…”