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Foveal Hypoautofluorescence: Does It Correlate to Visual Acuity in White Dot Syndromes?—Reply

Steven Yeh, MD; Farzin Forooghian, MD, MS; Wai T. Wong, PhD; H. Nida Sen, MD; Emily Y. Chew, MD; Robert B. Nussenblatt, MD, MPH
Arch Ophthalmol. 2010;128(12):1629-1630. doi:10.1001/archophthalmol.2010.279.
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In reply

We appreciate the interest and comments of the author regarding our article describing the various patterns of FAF in the WDS and the finding that foveal hypoautofluorescence occupying greater than or equal to 50% of the fovea (predominant) was correlated with worse visual acuity.1 While we did not specifically evaluate the foveola in our grading system, most cases in which at least 50% of the fovea was involved also demonstrate hypoautofluorescence in the foveolar region. As the author correctly mentions, we observed that there were occasional patients who demonstrated preserved visual acuity despite significant foveal but nonfoveolar involvement, although these patients typically demonstrated less than 50% involvement of the fovea. The grading scheme adopted for this study was aimed at assessing whether appreciable differences between foveal hypoautofluorescence and normal-appearing autofluorescence (ie, diffuse loss vs normal foveal autofluorescence pattern) could be related to loss of visual acuity. Intragrader and intergrader variability in deciding whether minimal, predominant, and no hypoautofluorescence was not specifically assessed in our study. However, of the 55 eyes assessed, discordance between graders was identified in only 1 eye (1.8%) and required a third-party adjudicator.

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