Imaging of retinal autofluorescence in patients with age-related macular degeneration

Background: Several studies have demonstrated an accumulation of autofluorescent materials in the retinal pigment epithelium (RPE) with increasing age. Histologic analysis revealed that lipofuscin is the most potential fluorescent substance in the aging RPE. Therefore, it has been speculated that lipofuscin precedes the presence of drusen and the development of age-related macular degeneration (ARMD). Method: A scanning laser ophthalmoscope was used to visualize autofluorescence in the fundus of patients with early ARMD. The digital recordings were analyzed offline with a digital image analyzing system. Results: In 85 of 103 patients, focal areas of increased autofluorescence were visible. Areas of hyperpigmentation at the level of the RPE showed increased autofluorescence in all cases, whereas areas of depigmentation demonstrated decreased autofluorescence. Conclusion: Patients with ARMD demonstrated focal accumulation of fluorescent material, most likely lipofuscin. Thus, the scanning laser technique combined with an image analyzing system may help to identify eyes at risk for developing exudative ARMD.