Delta Journal of Ophthalmology

: 2015  |  Volume : 16  |  Issue : 2  |  Page : 103--104

Geographic atrophy of the macula

Alaa M Fadel 
 Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

Correspondence Address:
Alaa M Fadel
Department of Ophthalmology, Faculty of Medicine, University of Alexandria, #9 Victor Bassily Street 02061, Alexandria


Geographic atrophy of the macula is a late form of dry AMD. Changes found on optical coherence tomography imaging (OCT) include Retinal Pigment Epithelium (RPE) atrophic changes and window defects, with a pronounced photorecetor layer damage.

How to cite this article:
Fadel AM. Geographic atrophy of the macula .Delta J Ophthalmol 2015;16:103-104

How to cite this URL:
Fadel AM. Geographic atrophy of the macula . Delta J Ophthalmol [serial online] 2015 [cited 2021 Dec 3 ];16:103-104
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Full Text

A 65-year-old man presented with difficulty in recognizing individuals by facial features and loss of ability to read (but the largest fonts) for the past few years.

The patient was hypertensive (controlled on treatment), not diabetic, and otherwise medically free. He had undergone bilateral cataract surgery more than 15 years ago. The left eye surgery was complicated and currently it has a vascularized opaque cornea and visual acuity of no light perception (NLP). The right eye had a 0.1 distance visual acuity with +1.00/−1.00 × 90°. The smallest font he could read was N 36 (with a +3.00 near addition). The right eye showed clear cornea, reasonably centered in-the-bag PC-intraocular lens (IOL), and a YAG laser-opened posterior capsule. Anterior segment was otherwise free and intraocular pressure was 16 mmHg. Fundus examination revealed healthy disc and arteriolar narrowing consistent with grade 2 hypertensive retinopathy and background fundus hypopigmentation that was most marked around the disc and at the macula, in which the lobular pattern of choroid pigmentation was unmasked margining the center of the macula [Figure 1].{Figure 1}

Fluorescein angiography showed normal dye transit time, normal retinal circulation, and normal disc fluorescence. The macula showed multiple hyperfluorescent ovoid patches of retinal pigment epithelium (RPE) atrophy and transmission defects, partially coalescent, with a geographic overall outline[Figure 2].{Figure 2}

Optical coherence tomography (OCT) showed clear vitreomacular interface, wide foveal pit contour with attenuation and fragmentation of the photoreceptor IS-OS junction layer, and marked thinning of the photoreceptor outer segments band at the fovea. The RPE appeared wavy with multiple humpy elevations, consistent with the presence of drusen [Figure 3].{Figure 3}


Geographic atrophy of the macula is one of the fates of age-related macular degeneration [1] . Drusen are believed to be a deposition of the metabolic wastes of the photoreceptor outer segments, after being engulfed and metabolized by the RPE. Some components of the drusen material appear to be toxic to the RPE, and its long-term presence seems to cause atrophy of the RPE cells. Photoreceptors are one of the highly metabolically active cell types in the body. Visual pigment metabolism is in particular highly dependent on the metabolic support of a well-functioning and healthy RPE [2] . Photoreceptor degeneration always follows RPE atrophy in a short time interval [3] .

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1Göbel AP, Fleckenstein M, Schmitz-Valckenberg S, et al. Imaging geographic atrophy in age-related macular degeneration. Ophthalmologica 2011; 226:182-190.
2Politoa A, Napolitano MC, Bandello F, et al. The role of optical coherence tomography (OCT) in the diagnosis and management of retinal angiomatous proliferation (RAP) in patients with age-related macular degeneration. Ann Acad Med Singapore 2006; 35:420-424.
3Fleckenstein M, Schmitz-Valckenberg S, Adrion C, et al. Tracking progression with spectral-domain optical coherence tomography in geographic atrophy caused by age-related macular degeneration. Invest Ophthalmol Vis Sci 2010; 51:3846-3852.