RPE tears on fundus autofluorescence (FAF) typically present which area corresponding to RPE loss?

RPE tears are associated with the loss of retinal pigment epithelium (RPE), which manifests as areas of hypoautofluorescence on fundus autofluorescence (FAF) imaging. This occurs because the RPE is crucial for maintaining various aspects of retinal health, including the recycling of photoreceptor visual pigments and providing support to the underlying photoreceptors. When there is an RPE defect or tear, the loss of this layer leads to a reduction in autofluorescence.

In FAF images, the areas where RPE has been lost will appear darker compared to the surrounding unaffected regions, creating a hypoautofluorescent area. This contrasts with hyperautofluorescent areas, which typically indicate regions with excess accumulation of lipofuscin or other substances due to dysfunction or degeneration processes, rather than direct tissue loss. As such, recognizing these hypoautofluorescent areas is essential for diagnosing and understanding the implications of RPE tears in conditions such as age-related macular degeneration (AMD) and other pathologies associated with choroidal neovascularization (CNV).