Changes in fundus autofluorescence in patients with age-related maculopathy. Correlation to visual function: a prospective study

Background: As members of the Fundus Autofluorescence in Age-related Macular Degeneration Study Group ( FAM Study Group), we report changes of fundus autofluorescence (AF) in patients with multiple soft drusen in correlation to visual function. Methods: Inclusion criteria were age > 50 years, the presence of soft drusen, visual acuity of 20/100 or better, and no previous laser treatment in the study eye. All patients underwent a detailed ophthalmological examination including ETDRS visual acuity, binocular funduscopy, and color fundus photography. AF imaging was performed with a confocal scanning laser ophthalmoscope following a standard protocol. We used the classification of the International Fundus Autofluorescence Classification Group (IFAG) for the description of the AF patterns. Results: One hundred and twenty-five patients ( 81 women, 44 men) aged from 55 to 86 years ( mean 70+/-7 years) were included in this prospective study. During follow-up ( mean 18+/-6 months), 6 of 35 eyes with patchy AF pattern developed exudative changes, as well as 2 eyes with focal - plaque-like AF pattern and 1 eye with reticular pattern at baseline. Geographic atrophy was seen in two eyes with focal AF pattern and one eye with focal - plaque-like pattern at baseline. A total of 11 eyes presented with severe visual loss (>= 6 ETDRS lines). Ten (91%) of these had patchy AF pattern. Conclusion: Imaging of fundus AF in patients with age-related maculopathy allows identification of different patterns of fundus AF. Our preliminary data suggest that a patchy pattern of AF indicates a relatively high risk of progression to age-related macular degeneration with visual loss.