¹ Department of Ophthalmology, University of Bonn, Ernst-Abbe-Strasse 2, 53127 Bonn, Germany
² Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
³ First Eye Hospital of Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland
⁴ Department of Ophthalmology, University of Wuerzburg, Josef-Schneider-Strasse 11, 97080 Wuerzburg, Germany
⁵ Department of Ophthalmology, University of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
⁶ Department of Ophthalmology, St Franziskus Hospital, Domagkstrasse15, 48149 Muenster, Germany
⁷ Institute for Medical Biometrics and Epidemiology, University of Munich LMU, Marchioninistrasse 15, 81377 Munich, Germany
⁸ Department of Ophthalmology, University of Bern Inselspital, 3010 Bern, Switzerland

Correspondence to:
Correspondence to:
Professor Frank G Holz
Department of Ophthalmology, University of Bonn, Ernst-Abbe-Strasse 2, D-53127 Bonn, Germany; frank.holz{at}ukb.uni-bonn.de

Aim: To describe and classify patterns of abnormal fundus autofluorescence (FAF) in the junctional zone of geographic atrophy (GA) in patients with age related macular degeneration.

Methods: Digital FAF images were recorded in 164 eyes of 107 patients using a confocal scanning laser ophthalmoscope (cSLO; excitation 488 nm, detection above 500 nm) as part of a prospective multicentre natural history study (FAM Study). FAF images were obtained in accordance with a standardised protocol for digital image acquisition and generation of mean images after automated alignment.

Results: Image quality was sufficient for classification of FAF patterns in 149 eyes (90.9%) with lens opacities being the most common reason for insufficient image quality. Abnormal FAF outside GA in 149 eyes was classified into four patterns: focal (12.1%), banded (12.8%), patchy (2.0%), and diffuse (57.0%), whereby 12.1% had normal background FAF in the junctional zone. In 4% there was no predominant pattern. The diffuse pattern was subdivided into four groups including reticular (4.7%), branching (27.5%), fine granular (18.1%), and fine granular with peripheral punctate spots (6.7%).

Conclusions: Different phenotypic patterns of abnormal FAF in the junctional zone of GA can be identified with cSLO FAF imaging. These distinct patterns may reflect heterogeneity at a cellular and molecular level in contrast with a non-specific ageing process. A refined phenotypic classification may be helpful to identify prognostic determinants for the spread of atrophy and visual loss, for identification of genetic risk factors as well as for the design of future interventional trials.

Abbreviations: AMD, age related macular degeneration; cSLO, confocal scanning laser ophthalmoscope; ETDRS, Early Treatment Diabetic Retinopathy Study; FAF, fundus autofluorescence; GA, geographic atrophy; HRA, Heidelberg retina angiograph; LF, lipofuscin; RPE, retinal pigment epithelium; VA, visual acuity

Keywords: fundus autofluorescence; confocal scanning laser ophthalmoscopy; age related macular disease; geographic atrophy; retinal imaging

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