Fundus photograph (right), fundus autofluorescence image (middle) and results for fundus perimetry with Goldmann III size test points (left) for two eyes with geographic atrophy secondary to AMD.
The yellow cross surrounded by a yellow circle on the fundus perimetry image represents the center of fixation. The color rectangles show the loss of local retinal sensitivity in comparison to age-adjusted normal values (scale on the right eye in 1 dB steps, blue color = normal function, red color = reduction of 23 dB).
Normal function (illustrated by predominantly blue rectangles surrounding atrophy) is observed in the presence of no increased autofluorescence intensity in the junctional zone of atrophy (A).
In contrast, many pale blue to green rectangles around atrophy (suggesting severe reduction in localized sensitivity) were measured in the second example where areas of increased autofluorescence signal in the junctional zone are present (B).
Topographic correlation of impaired function with increased autofluorescence intensity indicates in these two examples functional relevance of increased lipofuscin accumulation in patients with advanced atrophic age-related macular degeneration.
Illustration of the relationship between specific FAF phenotypes and atrophy progression for patients with GA due to AMD showing the baseline FAF image (left) and follow-up FAF image (right) for each eye, respectively.
The examples with no abnormal FAF abnormalities
(A, atrophy progression 0.02 mm2/year, follow-up 12 months) and with only small areas of focally increased autofluorescence at the margin of the atrophic patch
(B, 0.36 mm2/year, follow-up 15 months) have a less rapid atrophy enlargement compared to the examples with diffuse fine granular FAF pattern
(C, 1.71 mm2/year, follow-up 12 months) and with the banded type
(D, 2.52 mm2/year, follow-up 18 months) of increased FAF surrounding the GA. Very rapid atrophy progression was observed in eyes with the diffuse trickling FAF pattern
(E, 3.78 mm2/year, follow-up 18 months).
Retinal pigment epithelium tear following the CNV development secondary to AMD.
A: Fundus photograph.
B: FAF image. The enrolled retinal pigment epithelium at the inferior nasal part of the lesion is characterized by hyperpigmentation on fundus photography, whereas FAF imaging shows levels of increased signal. Furthermore, FAF imaging discloses marked reduced intensity over areas with RPE loss due to lack of lipofuscin and therefore allows the delineation of the borders of the lesion.
Illustration of a long-standing disciform scar in the right eye of an 86-year-old man.
A: Fundus photograph.
B: Near-infrared reflectance image.
C: Fundus autofluorescence image.
Fundus autofluorescence is severely decreased over the fibrotic area, which is surrounded by a rim of increased intensity. Persistent subretinal fluid which is mainly located in the inferior part of the macula presumably due to gravity effects exhibits increased autofluorescence intensity.
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Amsterdam Eye Hospital
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