Clinical
Vol 3 No 5 • October/November 2012 • International Journal of Ophthalmic Practice
Their FAF appearances are different: in one of them 
an area of hypofluorescence is seen ( Figure 19), and 
in the other only a pattern of ‘folds’ over the macula is 
noticed (Figure 20). Peripapillary atrophy
As stated above the optic disc normally shows no AF 
since it has no fluorophores. Peripapillary atrophy is a 
thinning of the retina and retinal pigment epithelium 
in the region immediately surrounding the optic nerve 
head, and can commonly be seen in high myopes, 
patients with glaucoma and elderly patients. With 
FAF peripapillary atrophy appears as an area darker 
than the optic disc and it has very distinct boarders. Some peripapillary atrophy cases have boarders of 
increased FAF which hypothetically is indicating an 
ongoing process in the RPE that surrounds the optic 
disc (Figures 21 and 22). An increased autofluores-
cence around the papillae, i.e. increased lipofuscin 
accumulation, has been found to be associated with 
glaucoma (Viestenz et al, 2006). In a case of peripapil-
lary atrophy, associated with glaucoma, hyperfluores-
cent changes around the optic disc can be seen (Figure 
23). FAF appearance similar to that found in peripap-
illary atrophy can also be seen in cases without any 
pathology (Figure 24). Discussion
As mentioned earlier, this is not a scientific compar-
ison between fundus photography and FAF, but a pres-
entation and illustration of the technique. This report 
is an attempt to describe the FAF technique in general 
and present some commonly seen conditions in which 
the relevance of our findings is related to previously 
published scientific FAF reports. However, this report 
should not be seen as a fully scientific evaluation of 
FAF because no statistical and/or scientific compar-
ison of colour fundus images and FAF are made and 
because only one FAF technique has been used. FAF imaging has the potential to provide extra infor-
mation on retinal health. From our experience of FAF 
imaging, and from using the Canon CR-2 PLUS™ in 
particular, some cases with fully normal appearance 
on the colour fundus image show abnormalities on the 
FAF image. This occurs in particular in degenerative 
conditions such as age-related macular changes. This 
is in agreement with studies evaluating the FAF tech-
nique (Bindewald-Wittich et al, 2010), and an example 
of this is seen in Figure 6, which could easily have 
been overlooked if an FAF image had not been taken. In the cases of the epiretinal membranes some of them 
were not noted before the abnormal FAF was seen and 
compared with the same area on the colour fundus 
image. In these cases the FAF is of help in interpreting 
the colour fundus image. The FAF function is not a 
replacement but a complement. When interpreting the 
pictures the colour fundus image and the FAF image 
pathologies such as, retinal detachment, retinal 
vascular occlusions, cataract surgery and macular 
holes, but are in most cases found in the absence of 
other ocular pathologies (Fraser-Bell et al, 2003). Epiretinal membranes are most often noticed when a 
patient complains about reduced visual acuity and/
or metamorphopsia and is easily confirmed by optical 
coherence tomography. It is not always obvious on a 
fundus photo. Below (Figures 17 and 18), images from 
two cases with an epiretinal membrane are shown. Figure 11. Female, 48 years, decimal visual acuity 
1.2. Fundus with nevus inferiorly. Drusen can be 
seen on the nevus. The corresponding FAF image 
is normal, not even the drusen are depicted. Figure 10.