Fundus autofluorescence in Extensive Macular Atrophy with Pseudodrusen (EMAP) and Diffuse Trickling Geographic Atrophy (DTGA).

Abstract

To establish whether Extensive Macular Atrophy with Pseudodrusen (EMAP) can be distinguished from the diffuse trickling phenotype in geographic atrophy (DTGA) secondary to age-related macular degeneration on the basis of its features on blue-light autofluorescence (BAF). We reviewed our prospectively maintained database to enroll patients with a diagnosis of EMAP, DTGA, and non-DTGA with a minimum follow-up of 1 year. Atrophic areas and growth rates were measured on BAF images, using the Heidelberg Region Finder tool. Circularity and roundness were chosen as atrophy shape descriptors, extracted using ImageJ, and compared between disease groups. A total of 28 EMAP, 27 DTGA, and 30 non-DTGA eyes were included in the analysis. The median follow-up time was around 3.5 years. EMAP was characterized by an irregular and elongated shape (low circularity and low roundness) and associated with a fast atrophy growth rate (3.6 mm2/year), compared with non-DTGA. However, these parameters were not significantly different between EMAP and DTGA. Our study found that EMAP and DTGA cannot be effectively differentiated on fundus autofluorescence: in both diseases, the macular atrophic area has a major vertical axis, fringed borders, and fast progression.