PURPOSE: To evaluate the OCT images of eyes with fovea-involved complete retinal pigment epithelial and outer retinal atrophy (cRORA) as well as best-corrected visual acuity (BCVA) to explore the pathogenesis of visual impairment and atrophy. DESIGN: Retrospective observational study. SUBJECTS: Data of eyes with cRORA associated with age-related macular degeneration with foveal center involvement were collected from 10 hospitals in Japan. METHODS: Ophthalmic examination data, BCVA, and extents of retinal pigment epithelial and outer retinal atrophy (RORA), represented by choroidal hyper-transmission, and outer plexiform layer (OPL) deterioration, central retinal thickness (CRT), and central choroidal thickness (CCT) measured using built-in software on the sectional OCT images were evaluated. MAIN OUTCOME MEASURES: Relationship between BCVA and extents of RORA and OPL deterioration. RESULTS: Of the 64 eyes of 64 patients (mean age: 76.8 ± 9.5 years old), 38 eyes (59.4%) belonged to men. Mean BCVA was 0.602 ± 0.475 (median: 0.523
range, -0.079 to 1.523) in logarithm of the minimum angle of resolution (logMAR). Mean extent of RORA was 2921 ± 1291 (median: 3172
range: 479-5985) μm. BCVA in logMAR positively correlated with extents of RORA ( CONCLUSIONS: A longer extent of cRORA in the OCT images with foveal center involvement was associated with a longer extent of OPL deterioration and the presence of cCOD and worse BCVA. Further studies focusing on OPL changes are warranted for understanding the pathogenesis of RORA and vision loss. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.