Comparison of Geographic Atrophy Measurements Between Blue-Light Heidelberg Standard Field and Green-Light Optos Ultrawide Field Autofluorescence

Abstract

Purpose: This study compared geographic atrophy (GA) measurements in the macula using standard 30° field and ultrawide field (UWF) fundus autofluorescence (FAF) imaging.

Methods: Participants from Age-Related Eye Disease Study 2 (AREDS2) and Optos PEripheral RetinA (OPERA) studies with GA were included for comparison between standard field FAF with Heidelberg Spectralis and Optos 200Tx UWF FAF. Two time points 5 years apart were evaluated. GA area (mm2) was recorded in the macular area for both imaging types and in the peripheral field for UWF.

Results: Of 102 paired images (73 subjects), the mean (SD) baseline GA area was 5.32 (6.36) mm2 with standard and 4.79 (5.87) mm2 with UWF FAF (P < 0.001). The mean difference between the two modalities was 0.52 mm2 (95% confidence interval, -2.41 to 1.37). Progression of GA in 25 eyes over 5 years showed a median annual growth rate of 1.28 mm2 (range, 0.02 to 4.7) for standard and 1.34 mm2 (range, 0.04 to 5.3) for UWF FAF (P = 0.49).

Conclusions: The measurement of GA is larger on standard than on UWF FAF imaging. The observed difference may be due to image averaging and the use of blue versus green FAF. Similar GA progression with standard and UWF FAF suggests either may be used longitudinally, although not interchangeably. Further investigation is required with updated UWF technology.

Translational relevance: With the increasing adoption of UWF imaging modalities, this study suggests that Optos UWF FAF may be used longitudinally as an alternative to standard field FAF to monitor GA.

Figure 1.

Fundus autofluorescence images of participant with geographic atrophy captured with Heidelberg 30° standard field (A) and Optos 200° ultrawide field—square outline represents a 30° field (B).

Figure 2.

Ungradable fundus autofluorescence images: due to geographic atrophy extension beyond standard field (A) with corresponding ultrawide field (B) and confluence with peripapillary atrophy in standard (C) and ultrawide field (D).

Figure 3.

Ultrawide field fundus autofluorescence image demonstrating peripheral nummular autofluorescence pattern consistent with cobblestone degeneration (arrow).

Figure 4.

Fundus autofluorescence grading review of >10% area difference between standard field (left) and ultrawide field (right) demonstrating no obvious difference (A, B) and image quality and visualization (C, D and E, F).

Figure 5.

Geographic atrophy progression between 5-year (A, B) and 10-year (C, D) time points observed on standard field (A, C) and ultrawide field (B, D).

Figure 6.

Bland–Altman plots: difference in GA measured on FAF between standard field and UWF FAF at (A) 5-year time point (n = 102 eyes) and (B) 10-year time point (n = 25 eyes). Grader reproducibility in GA measured on FAF with (C) standard field and (D) UWF.