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. 2025 Jul;14(7):1621-1632.
doi: 10.1007/s40123-025-01158-3. Epub 2025 May 5.

Imaging of Geographic Atrophy: A Practical Approach

Gregor S Reiter  1   2 , Enrico Borrelli  3   4 , Rosa Dolz-Marco  5 , Raymond Iezzi  6 , Sophie J Bakri  6
Affiliations

Imaging of Geographic Atrophy: A Practical Approach

Gregor S Reiter et al. Ophthalmol Ther. 2025 Jul.

Abstract

Geographic atrophy (GA) secondary to age-related macular degeneration is a chronic degenerative disease involving the retinal pigment epithelium, photoreceptors, and choriocapillaris leading to irreversible loss of visual function. Identification of imaging markers associated with GA development and progression has progressed over the past decades, moving from two-dimensional to three-dimensional imaging, as well as image interpretation using artificial intelligence. However, there is an open discussion about the "must-haves" for GA detection and follow-up as well as complementary imaging. This practical approach provides an overview of the advantages of key imaging modalities for GA and their applicability in clinical and experimental settings.

Keywords: Age-related macular degeneration; Fundus autofluorescence; Geographic atrophy; Imaging; Optical coherence tomography.

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Conflict of interest statement

Declarations. Conflict of interest: Gregor S. Reiter: consultant for Apellis, Bayer, Boehringer Ingelheim, Espansione, Nordic Pharma, and Roche and received research support from RetInSight. Enrico Borrelli: consultant for Abbvie, Bayer, Hofmann La Roche, and Zeiss. Rosa Dolz-Marco: consultant for Heidelberg Engineering and received research support from Roche, Apellis, and IvericBio. Raymond Iezzi: consultant for Johnson & Johnson. Sophie J. Bakri: consultant for Abbvie, Adverum, Allergan, Amgen, Annexon, Apellis, Aviceda, Cholgene, Eyepoint, ilumen, Iveric bio, Kala, Genentech, La Science Neurotech, Novartis, Ocular Therapeutix, Opthea, Outlook, Pixium, Regenxbio, Regeneron, Rejuvitas, Revana, Roche, VoxelCloud, and Zeiss and research support from Lowy Medical Foundation and Regenxbio. Ethical approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Major imaging modalities in a patient with geographic atrophy (GA) secondary to age-related macular degeneration (AMD). A Color fundus photography (CFP), B 488 nm wavelength fundus autofluorescence (FAF), C) Near-infrared reflectance (NIR) imaging, D-F) Optical coherence tomography (OCT) B-scans at the level indicated by the three yellow arrows in A
Fig. 2
Fig. 2
Influence of the device on the final optical coherence tomography (OCT) image within the same patient with geographic atrophy (GA). The Spectralis HRA + OCT (Heidelberg Engineering, Germany), Maestro2 (Topcon, Japan), and Cirrus HD-OCT (Carl Zeiss Meditec Inc., USA) are spectral-domain OCTs. While the Spectralis and Cirrus simultaneously generate a near-infrared reflectance (NIR) image, the Maestro2 acquires a color fundus photograph (CFP). The Triton DRI (Topcon, Japan) is a swept-source OCT and acquires a CFP
Fig. 3
Fig. 3
Representative images from a patient with geographic atrophy (GA). Fundus photography (left image) shows the area of GA as a hypopigmented region with increased visibility of the choroidal vessels. The same area (middle-left image) appears hypoautofluorescent on green autofluorescence imaging. On structural optical coherence tomography (OCT, middle-right image), GA is seen as a region characterized by the triad of retinal pigment epithelium (RPE) absence, associated photoreceptor loss, and hypertransmission signal in the choroid. By using a slab below Bruch’s membrane, an en face image can be obtained (right image), highlighting the hypertransmission defects (hyperTDs) secondary to RPE atrophy
See this image and copyright information in PMC

References

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