Perilesional Fundus Autofluorescence Patterns Are Not Static: Longitudinal Transitions in Geographic Atrophy and Association with Disease Progression

Purpose: To investigate cross-sectional characteristics and longitudinal changes in perilesional fundus autofluorescence (FAF) patterns in geographic atrophy (GA). Study Design: Retrospective cohort study. Participants: One hundred forty-three eyes from 99 patients (70 females) with foveal-sparing GA at baseline, of which 106 eyes from 76 patients were eligible for longitudinal analyses. Methods: Best-corrected visual acuity, FAF, and OCT findings were collected at all visits. Baseline FAF patterns were determined using a 5-item classification, with tracking of longitudinal changes. Changes in GA growth rate following pattern transitions were investigated through linear mixed models. Main Outcome Measures: Frequency and timing of perilesional FAF pattern transitions, and their association with GA growth rate. Results: Of the 106 eyes with follow-up, 23 (22%) showed a change in perilesional FAF pattern after a median of 3 years (interquartile range: 1.74–4.10). Square root GA growth rate was 0.40 mm/year (95% confidence interval [CI]: 0.34–0.46; P < 0.001), with modestly faster rate in “diffuse nontrickling” compared with “none” eyes (+0.06 mm/year; 95% CI: 0.004–0.12; P = 0.036) and slower rate in eyes showing FAF pattern transitions (–0.12 mm/year; 95% CI: –0.19 to –0.05; P < 0.001). Baseline lesion size and other FAF patterns were not significantly associated with progression (P > 0.05). Conclusions: Perilesional FAF pattern transitions occur in a subset of GA eyes and are marked by slower progression, underscoring their potential relevance for disease monitoring and clinical trial design. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.