RECLASSIFICATION OF FUNDUS AUTOFLUORESCENCE PATTERNS SURROUNDING GEOGRAPHIC ATROPHY BASED ON PROGRESSION RATE A Systematic Review and Meta-Analysis

Purpose: To reclassify fundus autofluorescence (FAF) patterns around geographic atrophy (GA) based on GA progression rates. Methods: MEDLINE, EMBASE, Cochrane Library, Clinicaltrials.gov, and PubMed were searched for studies reporting GA progression rates among different FAF patterns, such as None, Focal, Banded, Patchy, Diffuse Nontrickling, and Diffuse Trickling. The GA radius growth rate among different FAF patterns was compared, and a GA growth function for each group was derived. To account for the patients' different entry times, a horizontal translation factor was introduced to shift each data subset from time after enrollment to duration of GA. Results: Seven studies with 496 eyes were included. Based on GA radius growth rates, the six FAF patterns were clustered into four groups with a high correlation coefficient within each group: Group 1, None, 0.061 mm/year (r(2) = 0.996), Group 2, Focal, 0.105 mm/year (r(2) = 0.987), Group 3, Banded, Patchy, and Diffuse Nontrickling, 0.149 mm/year (r(2) = 0.993), and Group 4, Diffuse Trickling, 0.245 mm/year (r(2) = 0.997). Conclusion: This meta-analysis suggested that the six FAF patterns can be coalesced into four groups based on lesion progression rates. Simplification of the reclassified FAF patterns may shed light on the GA natural history and assist in the design of clinical trials.