Incomplete Retinal Pigment Epithelium and Outer Retinal Atrophy Characterized Using Fundus Autofluorescence: An 18-Month Post Hoc Analysis of GATHER2
In brief
Almost half of iRORA lesions that evolve to full atrophy show increased autofluorescence
In the GATHER2 cohort, 153 early-stage lesions (iRORA) were tracked for 18 months; those that progressed to complete atrophy (cRORA) were most often associated with increased autofluorescence on fundus imaging (44% of progressing lesions). The findings underscore that specific autofluorescence patterns may help predict which early lesions are likely to enlarge, though many iRORA lesions remain stable.
- Journal
- Investigative ophthalmology & visual science (Q1)
- Published
- 1 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Giulia Corradetti, Aditya Verma, Sophiana Lindenberg, Muneeswar Gupta Nittala, Swetha Velaga, Ayesha Karamat, et al.
- PMID
- 42484595
- DOI
- 10.1167/iovs.67.8.46
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 23 July 2026): FAF patterns characterize iRORA and progression to cRORA
Abstract
PURPOSE: To identify fundus autofluorescence (FAF) characteristics corresponding to incomplete retinal pigment epithelial and outer retina atrophy (iRORA), defined using optical coherence tomography (OCT), and progression of iRORA to complete lesions (cRORA). METHODS: In this GATHER2 (NCT04435366) post hoc analysis, pooled eyes from participants assigned to avacincaptad pegol (2 mg) or sham were analyzed for baseline iRORA beyond the borders of geographic atrophy; each iRORA was assessed for progression to cRORA at months 6, 12, and 18 using OCT. For each OCT-defined lesion at baseline and at each follow-up visit, FAF patterns were defined as none (no autofluorescence abnormalities), not classifiable, increased autofluorescence (IAF), questionably decreased (QDAF), or definite decreased (DDAF). RESULTS: Overall, 153 iRORA from 95 eyes were identified at baseline, and the majority demonstrated none (34.6%; n = 53) or QDAF (34.6%; n = 53) patterns. A smaller proportion of baseline iRORA exhibited a DDAF pattern (7.2%; n = 11). At month 18, the proportion of iRORA manifesting QDAF and DDAF patterns increased to 38.1% and 23.0%, respectively, and the none pattern decreased to 16.8%. The majority of lesions that remained as iRORA at month 18 demonstrated either none (52.8%) or QDAF (49.1%). iRORA that progressed to cRORA by month 18 was more likely to have more advanced FAF abnormalities, with 44.4% having IAF, 30.2% QDAF, and 27.3% DDAF. CONCLUSIONS: Findings from this large study reporting FAF characteristics of iRORA highlight the heterogeneity of these lesions and the association of the multimodal phenotype on progression over time.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.