Fundus autofluorescence (FAF) imaging is effective in determining the extent of retinal involvement in Stargardt disease (STGD) and may be prognostic, according to results published in Ophthalmology. Michel Michaelides, MD, and colleagues conducted a retrospective case series in 234 patients with STGD. Patients underwent electroretinogram (ERG) testing and ultra-widefield FAF imaging and were divided into three ERG groups based on retinal function and three FAF groups based on hypoautofluorescence extent and retinal appearance. The study found that 73% of patients had concordant ERG and FAF groups, while 14% had milder FAF than ERG and 13% had more severe FAF than ERG. Children younger than 10 had the lowest concordance; adults with adult-onset STGD had the highest. Missense genotypes were associated with milder phenotypes. In 80% of patients, FAF imaging accurately determined whether the disease was confined to the macula or affected the peripheral retina. However, in some cases, additional factors such as early disease onset and poor initial visual acuity may indicate wider retinal involvement or progression to a more severe FAF phenotype over time.
