American journal of ophthalmology | 2021
Fundus autofluorescence imaging in macular telangiectasia type 2 - MacTel Study Report Number 14: Fundus autofluorescence in macular telangiectasia type 2.
Abstract
PURPOSE\nTo investigate the role of fundus autofluorescence (FAF) imaging in the diagnosis of macular telangiectasia type 2 (MacTel) and to describe disease-associated FAF patterns and their origin.\n\n\nDESIGN\nCross-sectional multicenter study Methods: FAF images were collected from the multicentre MacTel Natural History Observation and Registry Study. In a first qualitative approach, common FAF phenotypes were defined and correlated with multimodal imaging. We then evaluated how many eyes showed FAF changes and temporal versus nasal asymmetry of FAF changes was graded. Finally, 100 eyes of MacTel patients and 100 control eyes (50 normal eyes and 50 eyes with other macular diseases) were combined and two masked graders assessed the presence of MacTel based on FAF images alone.\n\n\nRESULTS\nThe study included 809 eyes of 421 patients (33 eyes were excluded due to poor image quality). Loss of macular pigment, cystoid spaces, pigment plaques, neovascular membranes and ectatic vascular changes commonly caused characteristic changes on FAF images. All MacTel patients had macular FAF changes in at least one eye. In 95% of eyes, these changes were more pronounced temporally than nasally. Common FAF patterns were increased (60%), mixed/decreased FAF (38%), and/or visibility of vascular changes such as blunted vessels or ectatic capillaries (73%). Based on those features, high diagnostic performance was achieved for detection of the disease based on FAF alone (Youden s index up to 0.91).\n\n\nCONCLUSIONS\nThe study demonstrates that MacTel is consistently associated with disease-specific changes on FAF imaging. Those changes are typically more pronounced in the temporal parafovea.