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S.S. Dandekar, I. Leung, T. Peto, S. Jenkins, H.P. Scholl, A.R. Webster, A.C. Bird; Autofluorescence Findings in Patients with Unilateral Visual Loss Due to AMD . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1777.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To introduce a grading system for autofluorescence (AF) images and assess its ability to discriminate between lesions of AMD when compared with digital colour images.Methods: 101 patients with unilateral visual loss were identified from the London AMD phenotyping study. Colour images of both eyes were graded according to the international classification of ARM/AMD. AF images were obtained using a Zeiss or Heidelberg scanning laser ophthalmoscope and assessed independently using a grading system developed for the study. The results were compared with the colour images. Results: In the eyes with visual loss, 75 out of 82 eyes with choroidal neovascularisation (CNV) and all those with geographic atrophy (GA)(n=13) were correctly identified from the AF images (CNV- sensitivity 91.5%, specificity 94.7%; GA- sensitivity 100%, specificity 91%). One of 2 eyes with pigment epithelial detachment (PED) was correctly identified. In the remaining 4 cases, visual loss was due to soft drusen. In 3 of these, areas of GA were seen with AF imaging. In the fellow eyes, soft drusen was correctly graded in 52/69 cases (sensitivity 75%; specificity 75%), hard drusen in 6/13 cases and geographic atrophy in 13/14 cases. CNV was most commonly associated with a heterogeneous lesion of decreased AF with an ill-defined border (77%) and GA with a homogeneous area of decreased AF with a distinct border (74%). Scattered intermediate soft drusen was associated with a mottled pattern in 72% cases and larger parafoveal drusen and RPE change were both associated with more focal increases in AF in 43%. Conclusions: Lesions causing visual loss in AMD can be discriminated by AF imaging. CNV and GA have a characteristic appearance and can be identified with high levels of sensitivity and specificity. GA is more readily identified in those eyes with soft drusen and this may explain the cause for visual loss. AF of the fellow eye shows a mottled appearance causing greater disturbance of the retinal pigment epithelium with small scattered drusen compared to more focal increases seen with larger parafoveal drusen.
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