Functional and Structural Analysis of the Central Retina According to the Fundus Autofluorescence Pattern in Patients with Retinitis Pigmentosa

<b>Background:</b> This study evaluated morphological and functional differences among eyes with retinitis pigmentosa (RP) classified according to fundus autofluorescence (FAF) patterns. <b>Methods:</b> A total of 146 eyes from 73 patients with RP were analysed. Based on FAF imaging, eyes were classified as having regular hyperautofluorescent rings (n = 23), irregular rings (n = 76), or absent rings (n = 47). Participants underwent best-corrected visual acuity (BCVA), contrast sensitivity, 10-2 and 30-2 static perimetry, multifocal electroretinography (mfERG), and optical coherence tomography (OCT). FAF morphometrics included ring diameters and area. <b>Results:</b> Eyes with a regular FAF ring demonstrated significantly better visual function than those with irregular or absent rings, including higher BCVA (<i>p</i> < 0.001 and <i>p</i> = 0.001) and greater contrast sensitivity (both <i>p</i> < 0.001). The mfERG amplitude density in the first ring was higher in regular than irregular FAF patterns (<i>p</i> = 0.034). Eyes with irregular FAF showed more advanced visual field loss, with lower mean deviation on 10-2 (<i>p</i> = 0.042) and 30-2 perimetry (<i>p</i> = 0.027). In the regular-ring group, the ellipsoid zone was predominantly intact (<i>p</i> = 0.012). The hyperautofluorescent ring area correlated positively with mfERG amplitude density in the first and second rings (Rs = +0.573, <i>p</i> = 0.016; Rs = +0.736, <i>p</i> = 0.001) and with macular volume (Rs = +0.667, <i>p</i> = 0.003). <b>Conclusions:</b> FAF patterns reflect central retinal functional and structural impairment in RP. Therefore, incorporating FAF imaging into the diagnostic algorithm is valuable for monitoring disease progression.