FAF Findings May Help Determine Rhegmatogenous RD Duration

Rhegmatogenous retinal detachment (RRD) is a significant cause of acute vision loss, with an incidence of 12.17 per 100,000 people annually. While multimodal imaging methods such as OCT and ultrasonography can aid in identifying structural abnormalities, ultra-widefield (UWF) fundus autofluorescence (FAF) is gaining attention for its potential in preoperative assessments. A recent study, which compared the effectiveness of UWF color fundus photography and FAF in assessing patients with RRD, correlated various clinical features with imaging findings, particularly those indicative of retinal detachment duration.The research included a total of 93 eyes from 92 patients who presented with RRD at the Vanderbilt Eye Institute from 2022 to 2025. Patient records were reviewed to gather demographic data, symptom duration and clinical characteristics. The study excluded patients who did not have both color and FAF imaging at their initial presentation, those with total retinal detachments and cases where image quality was deemed inadequate. Widefield fundus autofluorescence may hold an advantage over color photography when it comes to surgical planning for patients with rhegmatogenous retinal detachments, researchers suggest. The modality provides qualitative data on the posterior extent of the detachment, hyperautofluorescent leading edge and the presence of hyperautofluorescent dots, all of which can help determine chronicity and urgency of surgery.These images from the study show (A, B) a typical acute, bullous detachment of less than two weeks duration. Note the hypoautofluorescence over the body of the detachment (white asterisk). The posterior border of the detachment is better appreciated on FAF (white arrows). Images C and D show a more shallow, chronic detachment of duration greater than two weeks with hyperautofluorescent dots in the area of detachment (white arrows). Photo: Zhang DL, et al. Ophthalmol Sci. November 21, 2025. [Epub ahead of print]. Click image to enlarge. Results demonstrated that 70% of patients had macular involvement, and 37% reported symptoms that lasted longer than two weeks (characterized as chronic cases). Both imaging modalities proved to be equally effective in evaluating critical parameters such as clock hours of detachment, the quadrants involved and whether there was any macular or foveal involvement. However, the study identified specific findings that differentiated the nature of the detachments.Bullous detachments were characterized by a distinct corrugated appearance on color photographs, indicating a significant association with more acute detachments and a pattern of uniform hypoautofluorescence across the detachment area. On FAF, the presence of a hyperautofluorescent leading edge was strongly linked to shorter symptom durations, specifically less than two weeks, while hyperautofluorescent dots within the detachment area correlated with longer symptom durations (greater than two weeks).  “This study adds to the existing literature on the utility of FAF in preoperative assessment of retinal detachment as it may allow clearer demarcation of detachment compared to fundus photographs, where the leading edge is only faintly visible,” the researchers commented in their paper for Ophthalmology Science. While color photography and FAF showed no significant differences in the general evaluation of macular and foveal status, the authors wrote that “in situations with borderline-appearing detachments that threaten the macula or fovea, this more pronounced leading edge on FAF may aid in characterization of detachment in conjunction with other imaging modalities such as OCT, which can also help delineate the extent of subretinal fluid and facilitate surgical triage.” The findings also suggest a novel correlation between the hyperautofluorescent leading edge and more acute detachments, which may inform the urgency of surgical intervention to halt progression and prevent vision loss, especially when patient history is ambiguous. They explained that hyperautofluorescence at the leading edge “may correspond with transiently increased metabolic activity of the RPE cells due to cell stress or excessive production of bisretinoid by impaired photoreceptors.”Given that this was an exploratory study, the researchers concluded, “Further confirmatory studies in combination with other imaging modalities such as OCT will be informative in determining the pathophysiology and visual implications of these imaging findings.”Click here for the journal source. Zhang DL, Bakis I, Dinh RH, Steinkerchner MS, Finn AP. Ultra-widefield fundus autofluorescence findings as an indicator of duration in rhegmatogenous retinal detachment. Ophthalmol Sci. November 21, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.