Characteristics and application value of ultra-wide-field fundus auto-fluorescence in Stargardt disease

AIM: To explore the characteristics and application value of ultra-wide-field auto-fluorescence in Stargardt disease. METHODS: A retrospective study of clinical characteristics and genetically confirmed Stargardt disease patients, using Optos P200Tx for ultra-wide-field auto-fluorescence imaging, and comparing the imaging features of traditional fundus color photographs, fundus 55° auto-fluorescence, and optical coherence tomography, to evaluate the ultra-wide-field auto-fluorescence in Stargardt disease image characteristics and advantages of clinical application. RESULTS:All 76 eyes(100%)had high posterior auto-fluorescence, while only 42 eyes(55%)of traditional 55° auto-fluorescence showed obvious posterior high auto-fluorescence. Sixty-six eyes(87%)of the 76 eyes showed different numbers of spots, which were distributed from the posterior pole to the peripheral retina. UWAF can show clearer and more number of retinal spots than fundus color photographs, and more completely shows the number and distribution of spots area. All 76 eyes(100%)of the patients showed the oval low auto-fluorescence area induced by retinal pigment epithelium(RPE)atrophy in the center of the macula. As the disease progressed, the atrophy area expanded and the low fluorescence area expanded accordingly. Ultra-wide-field auto-fluorescence can completely display the atrophy range and area, but it cannot display in dystrophy depth. In 48 eyes(63%)ultra-wide-field auto-fluorescence, strong background auto-fluorescence was seen extending from the macula to the nasal and inferior temporal of the optic disc, forming a clear approximately vertical dividing line below the optic disc.CONCLUSION: Ultra-wide-field auto-fluorescence changes in Stargardt are not limited to the posterior pole and may extend more peripherally. Ultra-wide-field imaging is a useful tool for the assessment of patients with Stargardt macular dystrophy