Prevalence and quantification of geographic atrophy associated with newly diagnosed and treatment-naïve exudative age-related macular degeneration

Objective To identify and quantify geographic atrophy (GA) associated with neovascular age-related macular degeneration (AMD) at initial presentation using a fundus autofluorescence (FAF) semi-automated software and to correlate the results with demographic and clinical data. Design Retrospective, observational study. Methods The study population consisted of treatment-naïve patients with newly diagnosed neovascular AMD. Best-corrected visual acuity, fundus photographs, infrared reflectance, FAF and spectral-domain optical coherence tomography were performed, associated with fluorescein and indocyanine green angiographies. Identification of GA was independently performed by three readers. Quantification of atrophy areas was done using RegionFinder Software (RFA), a semi-automated software embedded in Spectralis device (Heidelberg Engineering, Germany). Results We included 206 eyes of 173 consecutive patients (72% female, mean age: 79.7±9.1 years). Type I choroidal neovascularisation (CNV) was observed in 44.2% of eyes, type II CNV was observed in 20.9% and mixed CNV lesion was observed in 11.7%. Polypoidal choroidal vasculopathy was diagnosed in 7.7% and type III CNV was diagnosed in 15.5%. Analysis of FAF frames showed that GA was associated with nAMD in 46/206 eyes (22.3%). Taking into account data both from Region Finder and multimodal imaging, our results suggest that GA was present in 24.3% of eyes newly diagnosed with exudative AMD. Mean size of GA was 1.23±1.76 mm 2 (range 0.03-7.39). Conclusion GA is associated with nAMD in 1/4 of cases at initial presentation. Combined imaging, including RFA is an effective tool to identify and quantify GA at diagnosis.