PURPOSE: To investigate the association of spontaneous drusen regression in intermediate age-related macular degeneration (AMD) with changes on fundus photography and fundus autofluorescence (FAF) imaging. DESIGN: Prospective observational case series. METHODS: Fundus images from 58 eyes (in 58 patients) with intermediate AMD and large drusen were assessed over 2 years for areas of drusen regression which exceeded the area of circle C1 (diameter 125μm; Age-Related Eye Disease Study grading protocol). Manual segmentation and computer-based image analysis were used to detect and delineate areas of drusen regression. Delineated regions were graded as to their appearance on fundus photographs and FAF images, and changes in FAF signals were graded manually and quantitated using automated image analysis. RESULTS: Drusen regression was detected in approximately half of study eyes using manual (48%) and computer-assisted (50%) techniques. At year 2, the clinical appearance of areas of drusen regression on fundus photography was mostly unremarkable, with a majority of eyes (71%) demonstrating no detectable clinical abnormalities, and the remainder (29%) showing minor pigmentary changes. However, drusen regression areas were associated with local changes in FAF that were significantly more prominent than changes on fundus photography. A majority of eyes (64–66%) demonstrated a predominant decrease in overall FAF signal, while 14–21% of eyes demonstrated a predominant increase in overall FAF signal. CONCLUSIONS: FAF imaging demonstrated that drusen regression in intermediate AMD was often accompanied with changes in local autofluorescence signal. Drusen regression may be associated with concurrent structural and physiological changes in the outer retina
