Fundus Autofluorescence, Optical Coherence Tomography and Visual Acuity in Adult-Onset Foveomacular Dystrophy

Abstract

Aim: We investigated fundus autofluorescence (FA) patterns and tomographic retinal changes by means of optical coherence tomography (OCT 3) in adult-onset foveomacular vitelliform dystrophy (AOFVD) and their possible correlation with best-corrected visual acuity (BCVA). Methods: Eighteen eyes of 15 consecutive patients (mean age: 73.73 ± 9.5 years) presented to our observation with a diagnosis of AOFVD underwent BCVA measurement, evaluation of FA distribution by means of a confocal laser scanning ophthalmoscope and OCT 3 tomography. Results: The mean BCVA was 20/40 (range: 20/20–20/100). The FA pattern was patchy in 9 eyes (50%), ring-like in 5 (27.7%), focal in 3 (16.6%) and linear in 1 (5.5%). No correlation between FA patterns and BCVA was found. OCT 3 showed accumulation of highly reflective material between the neurosensory retina and retinal pigment epithelium (RPE) in 12 eyes (66.6%) with an evident overlying photoreceptor layer (PRL). In 5 eyes the highly reflective material was built up between the neurosensory retina and RPE without evidence of PRL (27.7%). Only in 1 eye was the subretinal accumulation site not well defined (5.5%). The mean thickness of the deposit was 135.52 ± 47.53 µm, while the residual neurosensory retina thickness was 103.94 ± 24.21 µm. The relationship between BCVA and the thickness of the neurosensory retina over the lesion was not significant (p = 0.016, r = 0.33), while the correlation between BCVA and the material deposit thickness (p = 0.017, r = 0.12) was significant. Conclusions: In AOFVD, FA presented different patterns, while OCT usually shows a well-defined material accumulation with a generally reduced neurosensory thickness between PRL and RPE. FA imaging and OCT are useful and safe for the diagnosis and follow-up of AOFVD.

Acquired Vitelliform Lesions

“…They did not find a correlation between visual acuity and these FAF patterns. 33 In our study, multimodal imaging demonstrated that abnormal hyperautofluorescence in eyes with AVLs localizes not only to the RPE but also to the material in the subretinal space.…”

Clinical applications of fundus autofluorescence in retinal disease

“…These vitelliform lesions emit increased autofluorescence [139, 140], while subsequent RPE atrophy results in hypo-autofluorescence [138]. Furino et al described three FAF patterns, including patchy, ring-like focal, and linear patterns, but did not find a correlation with progression or visual function [141]. Around the same time, a slightly larger study by Parodi et al identified three separate FAF patterns that progressed from normal, to focal, then to patchy hyper-autofluorescence, which correlated with visual acuity and retinal sensitivity.…”

A comparison of multifocal ERG and frequency domain OCT changes in patients with abnormalities of the retina

“…Numerous recent studies have demonstrated the clinical utility of the fdOCT technique in identifying local damage to the retina in diverse diseases including, but not limited to, retinal dystrophy [10, 11], acute macular neuroretinopathy [12–14], hydroxychloroquine toxicity [15–18], Stargardt disease [19, 20] and adult-onset vitelliform macular dystrophy [21–25]. In addition to being more accessible than the mfERG to clinicians, this technique has the advantage of being relatively easy and fast to perform.…”