Comparison of Multiple Techniques for Measuring Geographic Atrophy: A Systematic Review and Network Meta-Analysis

Abstract

This study compared techniques for measuring geographic atrophy (GA) against the standard autofluorescence blue (AF-Blue). The design was a Bayesian network meta-analysis. PubMed, Scopus, and Cochrane were searched for studies comparing GA imaging techniques. AF-Blue, autofluorescence green (AF-Green), autofluorescence infrared (AF-IR), near-infrared reflectance (NIR), multicolor autofluorescence AF (MC-AF), optical coherence tomography fundus image (OFI), en face sub-retinal pigment epithelium (SubRPE) slab, OCT angiography (OCTA), color fundus photography (CFP), and fluorescein angiography (FA) were included. A ratio of means (ROM) meta-analysis using a threshold based on an established minimally important difference was performed. (Pros-pero ID: CRD42023476459.) Included were 2,001 eyes from 18 studies and no significant differences among measurement techniques was found. The ROM showed that CFP, OCTA, SubRPE slab, OFI, and IR reflectance agreed well with AF-Blue. However, AF-Green, FA, and MC underestimated GA, and AF-IR overestimated it. It appears that there is a fair agreement between AF-Blue and current techniques for measuring GA. [Ophthalmic Surg Lasers Imaging Retina 2025;56:364-370.].