Electrodiagnostic and two-wavelength fundus autofluorescence imaging investigations in acute idiopathic maculopathy

The aim is to characterise a case of acute idiopathic maculopathy (AIM) using detailed electrophysiology and 2-wavelength fundus autofluorescence (FAF) imaging. A 32-year-old woman presented with reduced visual acuity in her right eye. Imaging investigations performed included 1 & 2 wavelength FAF, fluorescein and ICG angiography and Fourier domain OCT imaging. International-standard pattern and full-field electroretinography (PERG; ERG), electro-oculography (EOG) and multifocal ERG testing were performed. Multifocal ERGs demonstrated evidence of localised macular dysfunction consistent with mild right pattern ERG P50 reduction. Full-field ERGs were within normal limits. The EOG was normal bilaterally. The use of 1 & 2 wavelength FAF imaging revealed a low density macular area, not explained by luteal pigment absorption, that was associated with macular dysfunction. Two-wavelength FAF imaging allows the accurate quantification of macular pigment and the imaging of the underlying relative distribution of lipofuscin. AIM was characterised by a discrete area of disrupted retinal pigment epithelium metabolism and atrophy associated with localised macular dysfunction. Complimentary use of dual-wavelength FAF imaging and electrophysiology may have application to disorders other than AIM.