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PURPOSE: To further characterize a subgroup of patients exhibiting the fundus autofluorescence (FAF) "diffuse-trickling" phenotype associated with geographic atrophy (GA). METHODS: In the context of the Fundus Autofluorescence in Age-Related Macular Degeneration (FAM) Study, patients with diffuse-trickling GA were examined and characterized by FAF and spectral-domain optical coherence tomography imaging. Age, sex distribution, and medical history were compared with FAM study patients (n = 288, 60.1% female) with other GA phenotypes (non-diffuse-trickling). In a subset of patients, subfoveal choroidal thickness (SCT) was analyzed. RESULTS: Patients with diffuse-trickling (n = 61), compared with patients with non-diffuse-trickling GA, had a significantly younger age at first presentation (68.2 ± 11.6 vs. 75.4 ± 8.1 years, P < 0.001), a shift in the proportion of men from 55% in the age group younger than 65 to 19% in the age group older than or equal to 65, and a significantly higher rate of myocardial infarction (MI) in the age group younger than 65 (24% vs. 0%, P = 0.011); all but one patient with MI were male. Further evaluation revealed that in the age group younger than 65, 54% of patients with diffuse-trickling had been hospitalized due to cardiovascular diseases including hypertensive crisis, angina, and MI. Analysis of choroidal thickness revealed a significantly thinner SCT in diffuse-trickling compared with non-diffuse-trickling GA (135.2 ± 56.4 vs. 191.4 ± 77.8 μm, P < 0.001). CONCLUSIONS: The results indicate an association of diffuse-trickling GA with systemic cardiovascular disorders in the younger study population. Together with the ocular morphologic characteristics including a lobular appearance and a thin choroid, a vascular insufficiency at the level of the choroid may play a pathogenetic role in this distinct GA phenotype. (ClinicalTrials.gov number, NCT00393692.).

Original publication

DOI

10.1167/iovs.13-13409

Type

Journal article

Journal

Invest Ophthalmol Vis Sci

Publication Date

02/05/2014

Volume

55

Pages

2911 - 2920

Keywords

geographic atrophy, pathogenesis, phenotyping, retinal imaging, Age Distribution, Aged, Aged, 80 and over, Disease Progression, Female, Fluorescein Angiography, Fundus Oculi, Geographic Atrophy, Humans, Male, Middle Aged, Phenotype, Prospective Studies, Risk Factors, Sex Distribution, Visual Acuity