Perilesional Fundus Autofluorescence Patterns Are Not Static: Longitudinal Transitions in Geographic Atrophy and...

To investigate cross-sectional characteristics and longitudinal changes in perilesional fundus autofluorescence (FAF) patterns in geographic atrophy (GA).

Retrospective cohort study.

One hundred forty-three eyes from 99 patients (70 females) with foveal-sparing GA at baseline, of which 106 eyes from 76 patients were eligible for longitudinal analyses.

Best-corrected visual acuity, FAF, and OCT findings were collected at all visits. Baseline FAF patterns were determined using a 5-item classification, with tracking of longitudinal changes. Changes in GA growth rate following pattern transitions were investigated through linear mixed models.

Frequency and timing of perilesional FAF pattern transitions, and their association with GA growth rate.

Of the 106 eyes with follow-up, 23 (22%) showed a change in perilesional FAF pattern after a median of 3 years (interquartile range: 1.74-4.10). Square root GA growth rate was 0.40 mm/year (95% confidence interval [CI]: 0.34-0.46; P < 0.001), with modestly faster rate in "diffuse nontrickling" compared with "none" eyes (+0.06 mm/year; 95% CI: 0.004-0.12; P = 0.036) and slower rate in eyes showing FAF pattern transitions (-0.12 mm/year; 95% CI: -0.19 to -0.05; P < 0.001). Baseline lesion size and other FAF patterns were not significantly associated with progression (P > 0.05).

Perilesional FAF pattern transitions occur in a subset of GA eyes and are marked by slower progression, underscoring their potential relevance for disease monitoring and clinical trial design.

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