Multimodal Imaging for Evaluation and Quantification of Atrophy Progression in Extensive Macular Atrophy with Pseudodrusen.

Aim: To present the atrophy progression rate with fundus autofluorescence (FAF) and optical coherence tomography (OCT) findings in patients with extensive macular atrophy with a pseudodrusen-like appearance.

Methods: Eight patients who were followed up with the diagnosis of diffuse macular atrophy accompanied by pseudodrusen were included. Medical records, FAF, and OCT images at consecutive follow-ups were reviewed. Measurement of the atrophic area was performed on autofluorescence images using the Heidelberg RegionFinder software at baseline and each annual visit until the last available follow-up.

Results: The mean age was 56.75 ± 5.92 years (range, 45-65 years). Nyctalopia was observed in all patients. Macular atrophy of various sizes with a larger vertical diameter was present. Diffuse pseudodrusen-like deposits extending to the mid-peripheral retina were identified. The mean follow-up period was 38.33 ± 14.60 months (range, 26-60 months). The mean area of atrophy at baseline was 13.05 ± 7.93 mm² and reached 15.31 ± 7.93 mm² at the first-year follow-up (p<0.001). At the end of the follow-up period, the mean area of atrophy was 17.32 ± 7.90 mm² (p=0.001). The yearly rate of atrophy expansion was 2.13 mm²/year. The mean subfoveal choroidal thickness at baseline decreased markedly during the follow-up period (p=0.000).

Conclusions: The progression rate of macular atrophy in these patients is faster than the geographic atrophy associated with age-related macular degeneration. In this era of therapeutic options, it has become more important to assess atrophy progression. Distinguishing different macular atrophy forms may be crucial for selecting suitable candidates for future interventional treatments.