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B. Perumal, J. J. Lee, S. Bearelly, S. W. Cousins; Correlation of RPE Atrophy Measured With Fundus Autofluorescence With Visual Acuity Outcomes in Patients With NVAMD Responsive to Anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2238. doi: https://doi.org/.
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Vision loss in neovascular age-related macular degeneration (NVAMD) has been attributed to leakage from neovascularization. However, recent studies have shown that atrophy of the retinal pigment epithelium (RPE) observed with fundus autofluorescence (FAF) imaging may also correlate with visual acuity (VA) in eyes with new onset NVAMD. Here we correlate the amount of RPE atrophy observed in FAF images and VA outcomes in patients who demonstrate resolution of leakage after anti-vascular endothelial growth factor (anti-VEGF) therapy.
Patients with both NVAMD treated with an anti-VEGF and FAF images (HRA2 and Spectralis, Heidelberg Engineering) acquired between 1/1/05 and 10/31/07 were identified. FAF images of patients who demonstrated a significant anatomical response (evidenced by compact OCT) to anti-VEGF therapy within 1-15 months after the initial injection were analyzed. Using Adobe Photoshop, total area of decreased FAF, indicative of RPE atrophy, were quantified within a 7500µ circle centered on the macula. Ratios of decreased FAF areas to total FAF areas were generated. VAs from corresponding dates were compared. This study was approved by the Duke IRB.
24 eyes (24 patients) were identified. The average age was 80 years (range 60-87); 50% were female. Eyes were categorized by vision into good (20/20 to 20/40), moderate (20/50 to 20/160), and poor (20/200 or worse). Average ratios of decreased FAF to total FAF in these categories were 5.0%, 12.6%, and 23.8%, respectively. In eyes with less than 5% atrophy, the diagnostic power of FAF to exclude eyes with poor vision was 100% and to predict eyes with good vision was 57%. In eyes with more than 20% atrophy, the diagnostic power of FAF to exclude eyes with good vision was 100% and to identify eyes with poor vision was 60%.
The results demonstrate a strong correlation between the amount of RPE atrophy observed with FAF images and visual acuity outcomes. This suggests that RPE atrophy is another mechanism of vision loss in NVAMD. FAF imaging may be a useful tool in predicting visual outcomes in patients receiving anti-VEGF treatment for NVAMD.
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