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Updated: Aug 21, 2026
A Workflow to Quantitatively Determine Age-Related Macular Degeneration Lesion-Specific Variations in Fundus Autofluorescence
Published on: May 26, 2023
Predictive Value of Perilesional Fundus Autofluorescence Patterns and OCT-Based Ellipsoid Zone/Retinal Pigment
Julia Mai1,2, Gregor S Reiter1,2, Sophie Riedl1,2
1OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
Purpose:
To investigate the association between perilesional fundus autofluorescence (FAF) patterns and ellipsoid zone (EZ)/retinal pigment epithelium (RPE) loss ratio on OCT in geographic atrophy (GA) and their predictive value on disease progression and therapeutic response to pegcetacoplan.
Design:
Post hoc analysis of 2 prospective randomized controlled phase III clinical trials.
Subjects:
Patients with GA secondary to age-related macular degeneration.
Methods:
OCT and FAF images from the OAKS (NCT03525613) and DERBY (NCT03525600) trials, 2 phase III, randomized controlled clinical trials of intravitreal pegcetacoplan for the treatment of GA secondary to age-related macular degeneration, were analyzed. Retinal pigment epithelium and EZ loss were measured on OCT by previously validated deep learning-based algorithms. Perilesional FAF patterns were graded at a centralized reading center from the trials. Pooled study eyes and fellow eyes that met the inclusion/exclusion criteria were divided into 4 quartiles based on baseline EZ/RPE loss ratios on OCT. The distribution of FAF patterns between the quartiles was analyzed. The association between baseline FAF pattern and disease progression and therapeutic response to pegcetacoplan was investigated.
Main Outcome Measures:
Distribution of FAF patterns between EZ/RPE loss ratio quartiles, mean change in FAF-based GA growth, RPE, and EZ loss on OCT.
Results:
Fundus autofluorescence and OCT gradings were available for 1317 study and fellow eyes from both trials pooled together. The focal pattern showed smaller ratios (P < 0.001), whereas the diffuse-trickling pattern was present in higher ratios (P = 0.005) at baseline. All other patterns showed no correlation with EZ/RPE loss ratios. There was an association of the focal and the diffuse-trickling pattern with FAF-based GA progression and OCT-based RPE loss, but not with OCT-based EZ loss. A greater treatment effect was identified in eyes with the diffuse-trickling pattern, which was present in a small number of eyes.
Conclusions:
The focal and diffuse-trickling FAF patterns were associated with RPE loss; however, perilesional FAF patterns were not associated with photoreceptor degeneration. There was a greater treatment effect in eyes with the diffuse-trickling pattern, presenting with higher EZ/RPE loss ratios on OCT in a small subgroup.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
