Autofluorescence Signal Strength Can Inform Retinal Pigment Epithelium Tear Prognosis

The improvement of the autofluorescence signal, a smaller tear area and the absence of fibrosis at the site of a tear are all factors associated with better functional outcomes for patients with retinal pigment epithelium (RPE) tears secondary to neovascular age-related macular degeneration (wet AMD), according to a study published in Retina.

The cross-sectional, observational study included 48 eyes from 43 patients (mean age, 81.7±5.2 years, age range, 69-93 years, 31 women, 12 men) diagnosed with RPE tears secondary to wet AMD with at least 12 months of follow-up. Researchers analyzed best-corrected visual acuity (BCVA), retinal sensitivity (RS) using microperimetry, status of outer retinal layers and RPE resurfacing on optical coherence tomography, fibrosis, autofluorescence signal recovery using blue-light (BAF) and near-infrared autofluorescence (NIR-AF). 

The researchers observed that 34 eyes (71%) showed signs of tissue healing during the follow-up visit. RPE resurfacing was observed in 22 eyes, while fibrosis appeared in 21 eyes. Autofluorescence improved in 17 eyes using BAF and 7 eyes on NIR-AF, according to the report. 

Outer retinal layers were more frequently preserved with improvement of both RPE resurfacing and autofluorescence. (P <.05). BCVA was higher for smaller RPE tears (P =.01), and RS of the healing tissue was positively influenced by autofluorescence improvement (P <.001) and by the absence of fibrosis (P =.03). 

“The development of subretinal fibrosis negatively affected the retinal sensitivity of the rip area, but interestingly it did not reduce the visual acuity. This may be explained by the fact that BCVA is strongly dependent on the status of subfoveal photoreceptors and on the concomitant activity of the neovascular lesion, highlighting the importance of new functional modalities in the evaluation of patients with [wet AMD] such as microperimetry,” according to the researchers.

The study’s limitations include the limited sample size, single-center design, inadequate longitudinal follow-up with all of the imaging and functional test modalities reported. Also, most analyzed measures were performed manually, and researchers report an inability to exclude certain confounders, including outer retinal thinning, prior bleeding for BAF, and choroidal melanin for NIRAF.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.