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, 120 (6), 1271-7

Peripheral Autofluorescence and Clinical Findings in Neovascular and Non-Neovascular Age-Related Macular Degeneration


Peripheral Autofluorescence and Clinical Findings in Neovascular and Non-Neovascular Age-Related Macular Degeneration

Colin S Tan et al. Ophthalmology.


Purpose: To characterize peripheral fundus autofluorescence (FAF) abnormalities in patients with age-related macular degeneration (AMD), correlate these with clinical findings, and identify risk factors associated with these FAF abnormalities.

Design: Clinic-based, cross-sectional study.

Participants: A total of 119 consecutive patients: 100 patients with AMD (200 eyes) and 19 patients without AMD (38 eyes).

Methods: In a prospective study performed at the Doheny Eye Institute, University of Southern California, widefield 200-degree FAF and color images were obtained by the Optos 200Tx Ultra-Widefield device (Optos, Dunfermline, Scotland) using a standardized imaging protocol. The FAF images were captured centered on the fovea, and additional images were captured after steering the field of view inferiorly and superiorly. All FAF and color images were graded independently by 2 masked ophthalmologists with respect to the presence, location, extent, and type of peripheral (defined as outside the central 30 degrees) FAF abnormality.

Main outcome measures: Presence and type of peripheral FAF abnormalities.

Results: Peripheral FAF abnormalities were evident in 164 eyes (68.9%), with several distinct FAF patterns identified: granular (46.2%), mottled (34.0%), and nummular (18.1%). A 90% concordance of FAF patterns was observed between both eyes. Abnormal FAF occurred more frequently in neovascular compared with non-neovascular AMD or normal eyes (86% vs. 72.8% vs. 18.4%, respectively, P<0.001). Significant risk factors for peripheral FAF abnormalities were AMD type (neovascular AMD odds ratio [OR], 12.7 and non-neovascular AMD OR, 6.2 compared with normal eyes, P<0.001), older age (OR, 6.5; 95% confidence interval [CI], 2.4-17.8; P<0.001 for the oldest quartile compared with the youngest), and female sex (OR, 4.1; 95% CI, 1.9-8.9; P<0.001). Clinical features on color photography were detected in 174 eyes (73.1%): peripheral drusen (51.7%), retinal pigment epithelium (RPE) depigmentation (34.9%), RPE hyperpigmentation (branching reticular pigmentation) (22.7%), and atrophic patches (16.8%). There was a high correlation between specific FAF and clinical findings: granular FAF with peripheral drusen (P<0.001) and mottled FAF with RPE depigmentation (P<0.001).

Conclusions: Several distinct patterns of peripheral FAF abnormalities were observed in 68.9% of patients, with AMD type, female sex, and age being independent risk factors. The peripheral FAF patterns correlate strongly with specific clinical features seen in eyes with AMD.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Conflict of interest statement

Conflict of interest: No conflict of interest exists for any author.


Figure 1
Figure 1
Color and autofluorescence photographs illustrating FAF abnormalities and the associated clinical features. 1a. Color fundus photography illustrating peripheral drusen. 1b. FAF image showing granular increased autofluorescence corresponding to the drusen (white arrow). 1c. Areas of RPE atrophy in the nasal periphery. 1d. FAF image showing areas of nummular decreased autofluorescence (white arrow) corresponding to the RPE atrophy. 1e. Areas of RPE depigmentation in the periphery of the fundus. Small peripheral drusen are seen temporally 1f. FAF image demonstrating large areas of mottled decreased autofluorescence (white arrow) corresponding to the area of RPE depigmentation. Fine granular FAF are also seen temporally corresponding to peripheral drusen. (FAF = Fundus autofluorescence, RPE = retinal pigment epithelium)

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