Represents the most advanced form of nonneovascular AMD.
Pathogenesis is unclear, but may raise from:
Areas of confluent large, soft drusen that undergone regression
Multiple reticulated areas of hyper- or hypopigmentation (non-geographic atrophy) which may progress to one large area of GA, spreads contiguously around the fovea and eventually surrounding it
Spontaneous flattening of a pigment epithelial detachment
Clinical Features
Symptoms:
Gradual or progressive loss of vision, depending on the extend and the location of the atrophy relative to the foveal center
Reduced contrast sensitivity
Signs:
Single or multiple discrete areas of hypopigmentation or depigmentation or absent of the RPE forming an areolar pattern
Often appear as bilateral and symmetric disease, although they may have different onset and progression rates
Visualization of the larger caliber choroidal vessels within the atrophied area
May be accompanied by calcified drusen which appears as glistening, bright yellow specks
The areas of atrophy will continue to enlarge over time
Fluorescein angiography findings:
Early and discrete bright hyperfluorescence
Slowly or entirely absent of choriocapillaris filling within the GA zone
Persistent staining of the atrophied area with a maintaining border in the late phase