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Correlation between the Area of Increased Autofluorescence Surrounding Geographic Atrophy and Disease Progression in Patients with AMD

¹From the Department of Ophthalmology, University of Bonn, Bonn, Germany; the ²First Eye Hospital, University of Lublin, Lublin, Poland; the ³Institute for Medical Biometry and Applied Informatics, University of Heidelberg, Heidelberg, Germany; the ⁴Department of Ophthalmology, University of Bern, Bern, Switzerland; and the ⁵Department for Pathophysiology of Vision and Neuro-Ophthalmology, University Eye Hospital Tübingen, Tübingen, Germany.

PURPOSE. To test the hypothesis that the extension of areas with increased fundus autofluorescence (FAF) outside atrophic patches correlates with the rate of spread of geographic atrophy (GA) over time in eyes with age-related macular degeneration (AMD).

METHODS. The database of the multicenter longitudinal natural history Fundus Autofluorescence in AMD (FAM) Study was reviewed for patients with GA recruited through the end of August 2003, with follow-up examinations within at least 1 year. Only eyes with sufficient image quality and with diffuse patterns of increased FAF surrounding atrophy were chosen. In standardized digital FAF images (excitation, 488 nm; emission, >500 nm), total size and spread of GA was measured. The convex hull (CH) of increased FAF as the minimum polygon encompassing the entire area of increased FAF surrounding the central atrophic patches was quantified at baseline. Statistical analysis was performed with the Spearman’s rank correlation coefficient ().

RESULTS. Thirty-nine eyes of 32 patients were included (median age, 75.0 years; interquartile range [IQR], 67.8–78.9); median follow-up, 1.87 years; IQR, 1.43–3.37). At baseline, the median total size of atrophy was 7.04 mm² (IQR, 4.20–9.88). The median size of the CH was 21.47 mm² (IQR, 15.19–28.26). The median rate of GA progression was 1.72 mm² per year (IQR, 1.10–2.83). The area of increased FAF around the atrophy (difference between the CH and the total GA size at baseline) showed a positive correlation with GA enlargement over time ( = 0.60; P = 0.0002).

CONCLUSIONS. FAF characteristics that are not identified by fundus photography or fluorescein angiography may serve as a prognostic determinant in advanced atrophic AMD. As the FAF signal originates from lipofuscin (LF) in postmitotic RPE cells and since increased FAF indicates excessive LF accumulation, these findings would underscore the pathophysiological role of RPE-LF in AMD pathogenesis.

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				M. Fleckenstein, P. C. Issa, H.-M. Helb, S. Schmitz-Valckenberg, R. P. Finger, H. P. N. Scholl, K. U. Loeffler, and F. G. Holz High-Resolution Spectral Domain-OCT Imaging in Geographic Atrophy Associated with Age-Related Macular Degeneration Invest. Ophthalmol. Vis. Sci., September 1, 2008; 49(9): 4137 - 4144. [Abstract] [Full Text] [PDF]

				J. Hopkins, A. Walsh, and U. Chakravarthy Fundus autofluorescence in age-related macular degeneration: an epiphenomenon? Invest. Ophthalmol. Vis. Sci., June 1, 2006; 47(6): 2269 - 2271. [Full Text] [PDF]