A patient with advanced geographic atrophy presented with severe bilateral visual impairment. Best-corrected visual acuity was counting fingers at 2 meters. The patient’s medical history was notable for coronary artery bypass surgery performed 5 years earlier.
Multicolor and color fundus imaging demonstrated extensive bilateral macular and peripapillary RPE and outer retinal atrophy, accompanied by drusen in the temporal macula.
Fundus autofluorescence revealed extensive bilateral confluent atrophy with coalescent lobular borders, multiple satellite atrophic lesions, and diffuse abnormal autofluorescence extending beyond the junctional zone, consistent with the diffuse-trickling phenotype.
Spectral-domain OCT demonstrated marked loss of the outer retinal layers and RPE with increased choroidal hypertransmission, compatible with complete RPE and outer retinal atrophy (cRORA).
The diffuse-trickling FAF phenotype represents a distinctive pattern of geographic atrophy and is particularly important to recognize because it has been associated with more rapid atrophy progression compared with several other FAF phenotypes. An association with systemic cardiovascular disease, particularly in younger patients, has also been reported, suggesting a potential role for choroidal vascular insufficiency in its pathogenesis.
Credit: Kemal Tekin, M.D., from Ulucanlar Eye Training and Research Hospital
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