title: Increased Fundus Autofluorescence and Progression of Geographic Atrophy Secondary to Age-Related Macular Degeneration: The GAIN Study.
abstract: OBJECTIVE
  To define the role of increased fundus autofluorescence (FAF), a surrogate for lipofuscin content, as a risk factor for progression of geographic atrophy (GA).
  
  
  METHODS
  Prospective natural history cohort study, the GAIN (Characterization of geographic atrophy progression in patients with age-related macular degeneration).
  
  
  METHODS
  setting: Single-center study conducted in Barcelona, Spain.
  
  
  METHODS
  After screening of 211 patients, 109 eyes of 82 patients with GA secondary to age-related macular degeneration and a minimum follow-up of 6 months were included.
  
  
  METHODS
  Lipofuscin content was classified independently by 2 masked observers according to FAF patterns described previously. Bivariate, stratified, and multivariable analyses were used to explore the associations between GA growth and independent variables. Mediation analysis was used to evaluate the contribution of FAF patterns to GA progression.
  
  
  RESULTS
  Progression of GA in mm(2)/year as measured with FAF.
  
  
  RESULTS
  Median follow-up was 18 months (range, 6-42). Median GA growth was 1.61 mm(2)/year. FAF, baseline area of atrophy, and time of follow-up were independently associated with GA progression (P < .004). FAF patterns and baseline area of atrophy were strongly associated (P < .0001), suggesting potential confounding. Mediation analysis suggested that most of the effect of FAF patterns on GA growth was actually caused by baseline area of atrophy.
  
  
  CONCLUSIONS
  FAF patterns, baseline area of atrophy, and time of follow-up were associated with GA progression. However, FAF patterns seem to be a consequence (not a cause) of enlarging atrophy and their effect on GA progression seems mostly driven by baseline area of atrophy.
authors.affiliation: Institut de la màcula i de la retina (Centro Médico Teknon), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain. Electronic address: biarnes@oo.upc.edu.
authors.forename: Marc
authors.initials: M
authors.lastname: Biarnés
authors.affiliation: Hospital Universitari de Bellvitge, Barcelona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Arias
authors.affiliation: Universitat Pompeu Fabra (UPF), Barcelona, Spain; Health Services Research Unit, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Institut de la màcula i de la retina (Centro Médico Teknon), Barcelona, Spain.
authors.forename: Míriam
authors.initials: M
authors.lastname: Garcia
authors.affiliation: Institut de la màcula i de la retina (Centro Médico Teknon), Barcelona, Spain.
authors.forename: Míriam
authors.initials: M
authors.lastname: Hijano
authors.affiliation: Institut de la màcula i de la retina (Centro Médico Teknon), Barcelona, Spain.
authors.forename: Anabel
authors.initials: A
authors.lastname: Rodríguez
authors.affiliation: Institut de la màcula i de la retina (Centro Médico Teknon), Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Serrano
authors.affiliation: Institut de la màcula i de la retina (Centro Médico Teknon), Barcelona, Spain; Hospital Moisés Broggi, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Badal
authors.affiliation: Institut de la màcula i de la retina (Centro Médico Teknon), Barcelona, Spain.
authors.forename: Hussein
authors.initials: H
authors.lastname: Muhtaseb
authors.affiliation: Institut de la màcula i de la retina (Centro Médico Teknon), Barcelona, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Verdaguer
authors.affiliation: Institut de la màcula i de la retina (Centro Médico Teknon), Barcelona, Spain; Barcelona Macula Foundation, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Monés
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D005453:Fluorescence; D005500:Follow-Up Studies; D005654:Fundus Oculi; D057092:Geographic Atrophy / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008268:Macular Degeneration / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012160:Retina / Q000473:pathology*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology