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Digital Fundus Auto-fluorescence Mapping in Geographic Atrophy (GA) due to ARMD
Schmitz-Valckenberg S., Jorzik J., Schütt F., Holz F. G.,
Ruprecht-Karls-Universität Heidelberg, Universitäts-Augenklinik (Heidelberg)
Objective: GA is a cause for severe visual loss in late age-related macular degeneration (ARMD). Several lines of evidence indicate that ageing changes of the retinal pigment epithelium (RPE) play a key role in the pathogenesis. Using SLO fundus autofluorescence (AF) imaging we have shown the identification of incipient atrophy in vivo (IOVS 2001.42:1051-1056). We performed expanded cross-sectional and longitudinal studies to classify phenotypes and to identify prognostic factors.
Methods: Using a confocal SLO (exc. 488 nm; em: above 500 nm; Heidelberg Retina Angiograph) AF was recorded in 480 eyes in the FAM-(Fundus Autofluroescence in Age-related Macular Degeneration)Study. Retinal areas with abnormal AF, quantification of atrophic areas and longitudinal changes were studied. Using digital analysis software, progression of atrophic areas and abnormal AF in the junctional zone during an observation period of up to five years is illustrated in a video.
Results: Phenotypic types based on AF patterns in the junctional zone of GA included focal, diffuse, band and patchy homogenous pattern of abnormal AF while the enlargement or the development of new GA was confined to areas with elevated AF at baseline. Dependent on AF-type a progression rate of GA from 15% to 424% per year was observed.
Conclusions: Digital AF imaging in vivo allows identification of phenotypic GA subtypes. Different AF patterns may reflect heterogenous etiological changes on a molecular and cellular level, whereby GA represents a common downstream pathogenetic pathway. AF will also be useful in longitudinal natural history studies and for monitoring effects of present and future therapeutic interventions to slow down progression.
Support: DFG Ho 1926/2-1, DFG Priority Pogram AMD (SPP 1088), State of Baden-Wuerttemberg Research fund 500/2000