It has its maximum excitation at 
wavelengths between 490 and 530 nm. The reflection 
signal from the lipofuscin is affected by absorption 
from other macular pigments, blood vessels and the 
ocular media. The excitation wavelength is the wave-
length emitted by the camera. In order to avoid the 
camera just photographing the reflectance of its own 
excitation signal it has an emission filter that blocks 
certain wavelengths (Choudry et al, 2010). When excited, the lipofuscin shows as orange–red 
or golden–yellow granules, hyperfluorescence (Delori, 
2010). In complete tissue atrophy, e.g. geographic 
atrophy, where there is no lipofuscin the FAF pictures 
show black spots. Soft drusen appear as black in the 
middle (hypofluorescence) surrounded by a ring of 
white (hyperfluorescence) (Boulton, 2010). Normal and abnormal FAF appearance
The normal fundus shows diffuse homogeneous AF 
over most of the posterior pole (Bird, 2010). The FAF 
decreases towards the periphery (Delori, 2010) and 
it is most intense between 5 and 15 degrees from the 
fovea (Smith, 2010). Because the blood vessels absorb 
more light than the rest of the fundus, these structures 
appear darker on a FAF image. The optic disc has no 
fluorophores and will thus also appear as a dark circle 
(Bird, 2010). The macula will appear darker than the 
rest of the fundus since there is an increase of the 
pigment melanin which absorbs light. The overall 
level of lipofuscin, and so also the FAF, increases with 
age (Weiter et al, 1986). Fundus autofluorescence
— with the Canon CR-2 PLUS
Abstract
The aim of this report is to describe the principles of the fundus autofluorescence
(FAF) technique, and to illustrate common findings in normal and abnormal ocular
conditions by presenting both colour and FAF images captured with the Canon
CR-2PLUS™. The colour and FAF images are discussed in relation to scientifically
published reports on FAF findings in similar ocular conditions and with other FAF
cameras. Based on our experience the FAF images should be regarded as a supplement to
colour fundus images and has highest relevance when it comes to slow progressing
conditions rather than acute conditions. At present the knowledge about what FAF
shows and how it should be interpreted is broad, and it seems likely that the technique
will have a future not only in research and highly specialized retinal evaluations, but
also in daily clinical work. Mirjam Månsson BSc,
MSc is Optometrist,
Rune Brautaset   
BSc, MPhil, PhD is
Associate Professor,
Marika Walberg 
Ramsay BSc, PhD is
Optometrist,
Maria Nilsson 
BSc, PhD is Senior
Lecturer, all in the
Unit of Optometry at the
Department of Clinical
Neuroscience, Karolinska
Institutet, St Erik Eye
Hospital, Stockholm,
Sweden
Figure 1.