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Abstract
Purpose
We evaluated the progression of geographic atrophy (GA) based on fundus autofluorescence (FAF) pattern and atro-phy size using the fundus camera in non-exudative age-related macular degeneration (ARMD).
Methods
We acquired FAF images in non-exudative ARMD patients over a 2-year period. According to The Fundus Autofluorescence in Age-related Macular Degeneration (FAM) study, FAF patterns of geographic atrophy were classified into 5 categories. Examiners quantified the areas of GA in FAF images and analyzed the progression of atrophy based on FAF pattern and atrophy size.
Results
In 86 non-exudative ARMD eyes, elderly patients had faster progression rate of GA. The growth rates of GA were 1.51 mm2/year in ‘Diffuse’, 1.49 mm2/year in ‘Banded’, 1.05 mm2/year in ‘Patchy’, 0.59 mm2/year in ‘Focal’ and 0.16 mm2/year in ‘None’ pattern groups. In addition, the growth rate was 0.38 mm2/year in which initial the GA area was smaller than 1 disc area. This was the slowest progression rate among all categories according to initial GA area.
Conclusions
As a result of evaluating the progression of geographic atrophy using FAF over a 2-year period, the growth rate of GA was the fastest in the ‘Diffuse’ pattern group. Additionally, as the initial GA area became smaller, the progression of GA atro-phy was slower ( p < 0.002). Although limitations such as short follow-up period and measurement error of GA atrophy area using fundus photography were compensated, the results in the present study were similar to the outcomes of studies on progression of GA based on FAF pattern using the scanning laser ophthalmoscope over several years and the fundus camera for 1 year. In conclusion, the fundus camera is a useful tool for the prediction of long-term progression of GA in patients with non-exudative ARMD.
References
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Figure 1.
Demarcation of geographic atrophy and calculation of its size. The examiners used a computer mouse to trace all areas of GA around the macula manually. Geographic atrophy was recognized as well-demarcated black areas corresponding to the dead or absent RPE. The computer software automates conversion of pixels to square mm based on the magnification factors of the imaging device. (A-1) None. (A-2) The atrophic area highlighted in red in the upper image. (B-1) Focal. (B-2) The atrophic area highlighted in red in the upper image. (C-1) Patchy. (C-2) The atrophic area highlighted in red in the upper image. (D-1) Banded. (D-2) The atrophic area highlighted in red in the upper image. (E-1) Diffuse. (E-2) The atrophic area highlighted in red in the upper image. GA = geographic atrophy; RPE = retinal pigment epithelium.
Figure 2.
Eyes were classified depending on the total size of atrophy at baseline visit. Median atrophy enlargement per year is given below each box plot. Only the difference between the <1 DA group and the other groups was statistically significant ( p < 0.002). DA = disc area (2.54 mm2).
Table 1.
Baseline demographics and descriptive data
| Variable | Frequency (n = 86) |
|---|---|
| Age, mean (range) in years | 69.78 (51-93) |
| Male (%) | 43 (50.0) |
| Diabetes (%) | 25 (29.1) |
| Hypertension (%) | 43 (50.0) |
| Pattern of abnormal FAF∗ | |
| None or minimal change (%) | 18 (20.9) |
| Focal (%) | 12 (14.0) |
| Banded (%) | 16 (18.6) |
| Patchy (%) | 15 (17.4) |
| Diffuse (%) | 25 (29.1) |
Table 2.
Relationships between geographic atrophy progression and systemic variables using multiple linear regression with backward step-wise analysis
| β∗ ± SE | p-value | |
|---|---|---|
| Age | 0.013 ± 0.006 | 0.037 |
| Sex | 0.047 ± 0.152 | 0.760 |
| Diabetes | -0.065 ± 0.163 | 0.691 |
| Hypertension | -0.121 ± 0.149 | 0.420 |
Table 3.
Growth rates of GA by pattern of abnormal FAF
Table 4.
The number of patients and mean growth rate according to initial geographic atrophy area
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