title: In-vivo mapping of drusen by fundus autofluorescence and spectral-domain optical coherence tomography imaging.
abstract: OBJECTIVE
  To determine fundus autofluorescence (FAF) signal variations and corresponding microstructural alterations on spectral-domain optical coherence tomography (SD-OCT) in areas of funduscopically visible drusen associated with age-related macular degeneration (AMD).
  
  
  METHODS
  Thirty eyes from 22 patients with geographic atrophy (GA) secondary to AMD (median age 74, range 64-87 years), who had undergone retinal imaging including color fundus photography (CFP), FAF and SD-OCT (Spectralis HRA+OCT; Heidelberg Engineering GmbH, Heidelberg, Germany) were retrospectively analyzed. In each eye, at least one druse (≥ 63 μm) in the perilesional zone of GA recorded on CFP was analyzed. Relative FAF intensities and alterations in SD-OCT bands at the site of each druse were evaluated.
  
  
  RESULTS
  A total of 73 drusen were analyzed, which were associated with heterogeneous corresponding alterations on FAF and SD-OCT. The FAF signal was normal, increased, decreased or not evaluable in 32 (44 %), 27 (37 %), 12 (16 %), and 2 (3 %) drusen, respectively. Focal hyperreflectivity overlying drusen was most frequently spatially confined to increased FAF (present in 9 (33 %) of 27 drusen with increased FAF). Outer nuclear layer thinning and choroidal hyperreflectivity were associated with decreased FAF (present in 7 [58 %] of 12 and 6 [50 %] of 12 drusen with decreased FAF, respectively).
  
  
  CONCLUSIONS
  The appearance of soft drusen on CFP does not allow for differentiation between preserved and markedly compromised outer retinal integrity, including incipient atrophy and focal neurosensory alterations of reflectivity overlying extracellular sub-retinal pigment epithelium (RPE) deposits. Multimodal imaging reveals a broad spectrum of microstructural changes, which may reflect different stages in the evolution of drusen.
authors.affiliation: Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
authors.forename: Arno P
authors.initials: AP
authors.lastname: Göbel
authors.affiliation: Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Fleckenstein
authors.affiliation: Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
authors.forename: Tjebo F C
authors.initials: TF
authors.lastname: Heeren
authors.affiliation: Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
authors.forename: Frank G
authors.initials: FG
authors.lastname: Holz
authors.affiliation: Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany. steffen.schmitz-valckenberg@ukb.uni-bonn.de.
authors.forename: Steffen
authors.initials: S
authors.lastname: Schmitz-Valckenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D057092:Geographic Atrophy / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D061848:Optical Imaging; D012160:Retina / Q000473:pathology*; D015593:Retinal Drusen / Q000175:diagnosis*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence
keywords: Age-related macular degeneration; Drusen; Fundus autofluorescence; Geographic atrophy; Scanning laser ophthalmoscope; Spectral-domain optical coherence tomography