0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Quantitative Fundus Autofluorescence in Early and Intermediate Age-Related Macular Degeneration

Martin Gliem, MD1; Philipp L. Müller, MD1; Robert P. Finger, MD, PhD1,2; Myra B. McGuinness, MBiostat2; Frank G. Holz, MD1; Peter Charbel Issa, MD, DPhil1
[+] Author Affiliations
1Department of Ophthalmology, University Hospital of Bonn, Bonn, Germany
2Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
JAMA Ophthalmol. 2016;134(7):817-824. doi:10.1001/jamaophthalmol.2016.1475.
Text Size: A A A
Published online

Importance  Increased lipofuscin accumulation is assumed to be an important factor in the pathogenesis of age-related macular degeneration (AMD), although direct evidence for this hypothesis is missing.

Objective  To quantitatively investigate lipofuscin-associated fundus autofluorescence (AF) in patients with early and intermediate AMD.

Design, Setting, and Participants  A prospective, single-center, case-control study was conducted from August 1, 2014, to October 31, 2015, at a university referral center. Participants included 40 patients aged 65 years or younger and 108 individuals without eye disease serving as controls. All participants underwent quantitative fundus AF (qAF) imaging with a modified scanning laser ophthalmoscope equipped with an internal fluorescent reference. Mean qAF values of an 8-segment circular ring centered on the fovea (qAF8) were measured and compared between patients and controls. For subgroup analysis, drusen were categorized as soft drusen, cuticular drusen, and/or reticular pseudodrusen (RPD).

Main Outcomes and Measures  The qAF8 levels.

Results  In the 40 patients with AMD, mean (SD) age was 54.8 (5.6) years, and 32 (80%) were women. None of the investigated patients had qAF8 values above the 95% prediction interval (PI) of the 108 controls. In the soft drusen (28 [70%]) and cuticular drusen (8 [20%]) groups, qAF8 levels within the 95% PI were noted in 22 patients (79%; 95% CI, 60% to 90%) and 7 patients (88%; 95% CI, 51% to 99%) respectively. The qAF8 values in the RPD group (4 [10%]) were below the 95% PI in 3 patients (75%; 95% CI, 29% to 97%). Compared with the controls, statistical analysis revealed lower qAF8 values in the overall AMD cohort after adjusting for age (difference, −19.9% [95% CI, −25.6% to −12.7%], P < .001) as well as in all subgroups (soft drusen, −17.1% [95% CI, −24.1% to −9.5%], P < .001; cuticular drusen, −19.6% [95% CI, −30.3% to −7.2%], P = .003; and RPD, −34.5% [95% CI, −47.1% to −21.3%]; P < .001).

Conclusions and Relevance  The qAF8 measurements in this sample showed no increased lipofuscin-related fundus AF in patients with early and intermediate AMD. Lower qAF levels in certain subgroups may point to subnormal lipofuscin levels in the retinal pigment epithelium or, alternatively, limitations to detection of true retinal pigment epithelial lipofuscin content. The results of this study might expand the understanding of the pathogenesis of AMD and may have an effect on upcoming treatment trials that aim to modify lipofuscin accumulation.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Quantitative Fundus Autofluorescence (qAF) in Age-Related Macular Degeneration (AMD)

Mean qAF values of an 8-segment circular ring centered on the fovea (qAF8) of all individual patients with early or intermediate AMD compared with normative data. The blue line represents the regression curve and the dotted blue lines, the 95% prediction interval of the control individuals.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Quantitative Fundus Autofluorescence (qAF) Associated With Drusen Subtypes

From left to right, fundus color, fundus autofluorescence, and optical coherence tomographic images as well as mean qAF values of the 8-segment circular ring centered on the fovea (qAF8) of the investigated subgroups compared with the control individuals are shown. AMD indicates age-related macular degeneration; RPD, reticular pseudodrusen. In the graphs, the blue line indicates the regression curve; dotted lines, the 95% prediction interval of controls.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Color-Coded Quantitative Fundus Autofluorescence Maps in Age-Related Macular Degeneration

Images of an age-matched healthy control individual and characteristic patients with soft drusen, cuticular drusen, and reticular pseudodrusen. Quantitative values of the 8-segment circular ring centered on the fovea are shown in the lower right corner of each image.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.
Horizontal Quantitative Fundus Autofluorescence (qAF) Profiles of Representative Patients With Age-Related Macular Degeneration

The upper row shows the fundus autofluorescence (AF) image. In the middle row, the black line illustrates the qAF measures along the horizontal dotted white line in the AF image above, and the gray area indicates the mean (±1 SD) qAF profile of 45 age-matched controls. Lower row shows 5-fold magnification of areas of interest highlighted by the square superimposed on the AF image in the row above.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

1,493 Views
1 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();