Assessing Agreement between Blue-Light and Green-Light Autofluorescence of Macular Hyperautofluorescent Rings in Inherited Retinal Diseases

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Purpose To assess the agreement between blue autofluorescence (BAF) and green autofluorescence (GAF) fundus imaging in measuring the macular hyperautofluorescent (hyperAF) ring in patients with inherited retinal diseases (IRD). Design Prospective, within-subject agreement study. Subjects A total of 124 patients with IRD (67% with retinitis pigmentosa, 33% with cone-rod/macular dystrophies) from Moorfields Eye Hospital were included. Mean age was 36.5 years; 60% were male. Most (99%) had a genetically confirmed diagnosis. Methods Participants underwent BAF (Heidelberg) and GAF (Optos) imaging during the same visit. HyperAF ring area and horizontal and vertical diameters were independently measured by two ophthalmologists. Agreement between imaging modalities was assessed using intraclass correlation coefficients (ICC), Pearson's correlation, paired t-tests, linear and mixed-effects regression, Bland–Altman plots, and one-sided z tests for equivalence within a ±10% margin. Main Outcome Measures Comparison of hyperAF ring area and diameters between BAF and GAF. Results Inter-grader agreement was excellent (ICC: 0.93–0.98). BAF measured slightly larger ring areas than GAF (mean difference: 0.7 mm 2 , p=0.006), while horizontal and vertical diameters were nearly equivalent (mean differences: 0.03 μm and 0.08 μm, p=0.96 and p=0.04, respectively). Discrepancies greater than 10% were observed in 17% of cases in horizontal diameter, 27% of cases in vertical, and in 42% of cases in area. Correlations were high (r=0.98) for all metrics. Mixed-effects models including both eyes (n= 217) estimated that the area measured in GAF is 4.1% smaller than in BAF, the horizontal is approximately 0.5% smaller, and the vertical is around 2.2% smaller, with evidence of agreement within a ±6% margin at a 5% significance level. Conclusions High correlation and consistent regression slopes were seen between BAF and GAF macular hyperAF ring. These results suggest that whilst the two modalities yield broadly comparable measurements, with BAF yielding larger values, these modalities should ideally not be used interchangeably.

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