Table 9.

Summary of the typical findings identified on multimodal imaging in Stargardt disease.

Feature	Colour fundus imaging	Fluorescence angiography	ICGA	SW-AF imaging	NIR-AF imaging	Infrared image	Optical coherence tomography	Optical coherence tomography angiography	Adaptive optics
Flecks	Yellow-white flecks	Usually hypofluorescent flecks but can sometimes be hyperfluorescent	Hypofluorescent and do not always correspond to flecks seen in colour photographs	Typically hyperfluorescent and resorbed flecks can be hypofluorescent	Typically hypofluorescent	Typically, hyperreflective, while resorbing flecks are hyporeflective	hyper-reflective deposits	Hyperreflective deposits	Highly reflective structures that are not arranged in a contigious mosaic
Atrophy	‘Beaten bronze’ appearance. The atrophic area that can sometimes be associated with visible choroid and pigmentary deposition	Hyperfluorescent	Dark region surrounded by a ring of increased signal	Decreased AF signal	Decreased AF signal	Hyperreflective region that is usually surrounded by a darker less reflective ring	Disruption/ loss of the RPE layer (difficult to discern) and loss of the EZ	Disruption/loss of the RPE layer (difficult to discern) and loss of the EZ	Brightly oversaturated
Other features identified specifically by modality	UWF imaging can show peripheral pigmented lesions in some patients	Dark choroid sign	Reticular pattern of decreased fluorescence		Flecks and atrophy usually more advanced than those seen in SW-AF		Thickening of the ELM in early disease	Absence of choriocapillaris in macular areas of EZ loss	Increased cone spacing Enlarged photoreceptors Increased cone: rod ratio

AF, autofluorescence; ELM, external limiting membrane; EZ, ellipsoid zone; ICGA, indocyanine green angiography; NIR-AF, near infrared-wavelength autofluorescence; RPE, retinal pigment epithelium; SW-AF, short-wavelength autofluorescence; UWF, ultra-widefield.