Background/Objective: To evaluate if fundus autofluorescence (FAF) patterns around geographic atrophy (GA) and the status of the fellow eye have an impact on GA progression. Methods: We included 54 eyes of 35 patients with GA. Areas of GA were quantified by RegionFinder software. Results: GA progression rates in eyes with a diffuse trickling pattern (median 1.42 mm2/year) were significantly higher than in normal eyes (median 0.22 mm2/year) and eyes with other diffuse FAF patterns (median 0.46 mm2/year). Eyes with a banded pattern had a significantly higher progression rate (median 0.81 mm2/year) than those without any FAF abnormalities (p = 0.038). The group with baseline total atrophy of the eyes <1 disk area (DA; median 0.42 mm2) had an inverse relation with GA progression compared to the groups with baseline atrophy >1 DA (p < 0.05). Conclusion: Diffuse trickling and banded patterns may have an impact on GA progression and may serve as prognostic factors.

Keywords:
Age-related macular degeneration, Geographic atrophy, Fundus autofluorescence, Progression
1.
Bressler NM: Age-related macular degeneration is the leading cause of blindness. JAMA 2004;291:1900-1901.
2.
Friedman DS, O'Colmain BJ, Munoz B, Tomany SC, McCarty C, de Jong PT, Nemesure B, Mitchell P, Kempen J; Eye Diseases Prevalence Research Group: Prevalence of age-related macular degeneration in the United States. Arch Ophthalmol 2004;122:564-572.
3.
Klein R, Klein BE, Knudtson MD, Meuer SM, Swift M, Gangnon RE: Fifteen-year cumulative incidence of age-related macular degeneration: the Beaver Dam Eye Study. Ophthalmology 2007;114:253-262.
4.
Klein R, Davis MD, Magli YL, Segal P, Klein BE, Hubbard L: The Wisconsin age-related maculopathy grading system. Ophthalmology 1991;98:1128-1134.
5.
Mitchell P, Smith W, Attebo K, Wang JJ: Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study. Ophthalmology 1995;102:1450-1460.
6.
Sunness JS, Gonzalez-Baron J, Applegate CA, Bressler NM, Tian Y, Hawkins B, Barron Y, Bergman A: Enlargement of atrophy and visual acuity loss in the geographic atrophy form of age-related macular degeneration. Ophthalmology 1999;106:1768-1779.
7.
Sunness JS: The natural history of geographic atrophy, the advanced atrophic form of age-related macular degeneration. Mol Vis 1999;5:25-29.
8.
Augood CA, Vingerling JR, de Jong PT, Chakravarthy U, Seland J, Soubrane G, Tomazzoli L, Topouzis F, Bentham G, Rahu M, Vioque J, Young IS, Fletcher AE: Prevalence of age-related maculopathy in older Europeans: the European Eye Study (EUREYE). Arch Ophthalmol 2006;124:529-535.
9.
Boulton M, Dayhaw-Barker P: The role of the retinal pigment epithelium: topographical variation and ageing changes. Eye 2001;15:384-389.
10.
Schütt F, Davies S, Kopitz J, Holz FG, Boulton ME: Photodamage to human RPE cells by A2-E, a retinoid component of lipofuscin. Invest Ophthalmol Vis Sci 2000;41:2303-2308.
11.
Radu RA, Han Y, Bui TV, Nusinowitz S, Bok D, Lichter J, Widder K, Travis GH, Mata NL: Reductions in serum vitamin A arrest accumulation of toxic retinal fluorophores: a potential therapy for treatment of lipofuscin-based retinal diseases. Invest Ophthalmol Vis Sci 2005;46:4393-4401.
12.
Lindblad AS, Lloyd PC, Clemons TE, Gensler GR, Ferris FL 3rd, Klein ML, Armstrong JR: Change in area of geographic atrophy in the Age-Related Eye Disease Study: AREDS report No 26. Arch Ophthalmol 2009;127:1168-1174.
13.
Schmitz-Valckenberg S, Jorzik J, Unnebrink K, Holz FG: Analysis of digital scanning laser ophthalmoscopy fundus autofluorescence images of geographic atrophy in advanced age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2002;240:73-78.
14.
Sarks SH: Ageing and degeneration in the macular region: a clinico-pathological study. Br J Ophthalmol 1976;60:324-341.
15.
Von Ruckmann A, Fitzke FW, Bird AC: Fundus autofluorescence in age-related macular disease imaged with a laser scanning ophthalmoscope. Invest Ophthalmol Vis Sci 1997;38:478-486.
16.
Bindewald A, Jorzik JJ, Loesch A, Schutt F, Holz FG: Visualization of retinal pigment epithelial (RPE) cells in vivo using digital high-resolution confocal scanning laser ophthalmoscopy. Am J Ophthalmol 2004;137:556-568.
17.
Bindewald A, Roth F, Schmitz-Valckenberg S, Scholl HPN, Holz FG: Fundus autofluorescence imaging; in Holz FG, Spaide RF (eds): Medical Retina. Berlin, Springer, 2005, pp 19-34.
18.
Delori FC, Dorey CK, Staurenghi G, Arend O, Goger DG, Weiter JJ: In vivo fluorescence of the ocular fundus exhibits retinal pigment epithelium lipofuscin characteristics. Invest Ophthalmol Vis Sci 1995;36:718-729.
19.
Holz FG, Bellmann C, Margaritidis M, Schütt F, Otto TP, Völcker HE: Patterns of increased in vivo fundus autofluorescence in the junctional zone of geographic atrophy of the retinal pigment epithelium associated with age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 1999;237:145-152.
20.
Holz FG, Bellmann C, Staudt S, Schütt F, Völcker HE: Fundus autofluorescence and development of geographic atrophy in age-related macular degeneration. Invest Ophthalmol Vis Sci 2001;42:1051-1056.
21.
Delori FC, Fleckner MR, Goger DG, Weiter JJ, Dorey CK: Autofluorescence distribution associated with drusen in age-related macular degeneration. Invest Ophthalmol Vis Sci 2000;41:496-504.
22.
Wing GL, Blanchard GC, Weiter JJ: The topography and age relationship of lipofuscin concentration in the retinal pigment epithelium. Invest Ophthalmol Vis Sci 1978;17:601-607.
23.
Weiter JJ, Delori FC, Wing GL, Fitch KA: Retinal pigment epithelial lipofuscin and melanin and choroidal melanin in human eyes. Invest Ophthalmol Vis Sci 1986;27:145-152.
24.
Dorey CK, Wu G, Ebenstein D, Garsd A, Weiter JJ: Cell loss in the aging retina. Relationship to lipofuscin accumulation and macular degeneration. Invest Ophthalmol Vis Sci 1989;30:1691-1699.
25.
Jorzik JJ, Bindewald A, Dithmar S, Holz FG: Digital simultaneous fluorescein and indocyanine green angiography, autofluorescence, and red-free imaging with a solid-state laser-based confocal scanning laser ophthalmoscope. Retina 2005;25:405-416.
26.
Holz FG, Bellmann C, Rohrschneider K, Burk RO, Völcker HE: Simultaneous confocal scanning laser fluorescein and indocyanine green angiography. Am J Ophthalmol 1998;125:227-236.
27.
Bindewald A, Jorzik JJ, Roth F, Holz FG: cSLO digital fundus autofluorescence imaging (in German). Ophthalmologe 2005;102:259-264.
28.
Schmitz-Valckenberg S, Brinkmann CK, Alten F, Herrmann P, Stratmann N, Göbel AP, Fleckenstein M, Diller M, Jaffe GJ, Holz FG: Semiautomated image processing method for identification and quantification of geographic atrophy in age-related macular degeneration. Invest Ophthalmol Vis Sci 2011;52:7640-7646.
29.
Holz FG, Bindewald-Wittich A, Fleckenstein M, Dreyhaupt J, Scholl HP, Schmitz-Valckenberg S: Progression of geographic atrophy and impact of fundus autofluorescence patterns in age-related macular degeneration. Am J Ophthalmol 2007;143:463-472.
30.
Göbel AP, Fleckenstein M, Schmitz-Valckenberg S, Brinkmann CK, Holz FG: Imaging geographic atrophy in age-related macular degeneration. Ophthalmologica 2011;226:182-190.
31.
Bindewald A, Schmitz-Valckenberg S, Jorzik JJ, Dolar-Szczasny J, Sieber H, Keilhauer C, Weinberger AW, Dithmar S, Pauleikhoff D, Mansmann U, Wolf S, Holz FG; The FAM-Study Group: Classification of abnormal fundus autofluorescence patterns in the junctional zone of geographic atrophy in patients with AMD. Br J Ophthalmol 2005;89:874-878.
32.
Ambati J, Ambati BK, Yoo SH, Ianchulev S, Adamis AP: Age-related macular degeneration: etiology, pathogenesis, and therapeutic strategies. Surv Ophthalmol 2003;48:257-293.
33.
Lin JM, Tsai YY, Wan L, Lin HJ, Tsai Y, Lee CC, Tsai CH, Tsai FJ, Tseng SH: Complement factor H variant increases the risk of age-related macular degeneration. Science 2005;308:419-421.
34.
Edwards AO, Ritter R III, Kenneth JA, Manning A, Panhuysen C, Farrer LA: Complement factor H polymorphism and age-related macular degeneration. Science 2005;308:421-424.
35.
Klein RJ, Zeiss C, Chew EY, Tsai JY, Sackler RS, Haynes C, Henning AK, SanGiovanni JP, Mane SM, Mayne ST, Bracken MB, Ferris FL, Ott J, Barnstable C, Hoh J: Complement factor H polymorphism in age-related macular degeneration. Science 2005;308:385-389.
36.
Gold B, Merriam J, Zernant J: Variation in factor B (FB) and complement component 2 (C2) genes is associated with age-related macular degeneration. Nat Genet 2006;38:458-462.
37.
Schatz H, McDonald HR: Atrophic macular degeneration. Rate of spread of geographic atrophy and visual loss. Ophthalmology 1989;96:1541-1551.
38.
Klein R, Meuer SM, Knudtson MD, Klein BE: The epidemiology of progression of pure geographic atrophy: the Beaver Dam Eye Study. Am J Ophthalmol 2008;146:692-699.
39.
Fleckenstein M, Schmitz-Valckenberg S, Adrion C, Visvalingam S, Göbel AP, Mössner A, von Strachwitz CN, Mackensen F, Pauleikhoff D, Wolf S, Mansmann U, Holz FG; FAM Study Group: Progression of age-related geographic atrophy: role of the fellow eye. Invest Ophthalmol Vis Sci 2011;52:6552-6557.
40.
Sunness JS, Gonzalez-Baron J, Bressler NM, Hawkins B, Applegate CA: The development of choroidal neovascularization in eyes with the geographic atrophy form of age-related macular degeneration. Ophthalmology 1999;106:910-919.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.