Clinical
International Journal of Ophthalmic Practice • Vol 3 No 5 • October/November 2012 
reticular; and speckled. Hence, AMD can show 
many different appearances on a FAF image. They 
stated that although both soft and hard drusen can 
be seen on the colour fundus image, the FAF could 
be normal (classified as normal) or have very small 
changes without an obvious pattern (classified as 
minimal change). The FAF can show one or more 
spots of increased FAF with well defined boarders 
(focal increased), larger areas of increased FAF 
without well defined boarders (patchy), a linear area 
of increased FAF with well defined boarders (linear), 
a lacelike pattern over macula (lacelike), areas of 
decreased FAF with brighter lines in between all 
over the fundus (reticular) and multiple areas of 
both increased and decreased FAF that covers more 
than just the macula (speckled). Because of the char-
acteristics of these FAF patterns, the technique has 
great potential for being useful when a colour fundus 
image does not reveal everything. Our experience from using the Canon CR-2 PLUS™, 
is that variations in FAF are commonly seen around 
the papillae. It is rare that these variations can be 
correlated to any obvious pathology such as increased 
intraocular pressure (IOP), reduced visual acuity or 
visual field defects. One study carried out by Laemmer 
et al (2007) investigated FAF findings in eyes with 
diagnosed ocular hypertension and found that patients 
with ocular hypertension had an increased amount 
of peripapillary FAF compared with patients with 
normal IOP. Further, a previous study by Jonas and 
Naumann (1989) has shown that extension of peri-
papillary atrophy is an indicator of progressive glau-
comatous changes. There is very little written about 
glaucoma and FAF imaging, perhaps because it mainly 
involves the nerve fibre layer and therefore does not 
show on a FAF image. Laemmer et al (2007) concluded 
that when the peripapillary atrophy extends, because 
of hypertension, the RPE around it gets involved; lipo-
fuscin gathers and shows an increased FAF signal. Therefore it could be hypothesized that patients 
with ocular hypertension with increased peripapil-
lary autofluorescence are at higher risk of converting 
into glaucoma (Viestenz et al, 2006). If this is the case, 
FAF could be of help in distinguishing those who will 
convert and those who will not. The fact that almost all nevi we photographed 
showed normal FAF is of great clinical value. This is in concordance with Lavinsky (2010) who 
found no characteristic FAF patterns for nevi while 
melanomas often showed a plaque-like pattern of 
hyperfluorescence. Our experience is that drusen 
on top of a nevus does not show on FAF. Kanski 
(2007) states that nevi can be presented with surface 
drusen, which is normal. The drusen might or 
might not show on a FAF picture. Some nevi show 
an evenly distributed slightly darker FAF over the 
nevus, which correlates with the findings of Shields 
Figure 22. Male, 63 years, decimal visual acuity 
0.8. Myopia of -17 D. A thin retina and large 
peripapillary atrophy can be seen on the colour 
fundus image. The FAF image shows the optic 
disc as dark grey and the atrophy as black with 
distinct boarders. The FAF in the rest of the 
fundus is normal. Figure 23. Female, 89 years, decimal visual 
acuity 0.3. Diagnosed glaucoma. Intraocular  
pressure at the time was 18/19. Hyperfluorescence 
can be seen around the papillae which might be  
associated with glaucoma. Figure 24.