Clinical
Vol 3 No 5 • October/November 2012 • International Journal of Ophthalmic Practice
Figure 4. Female, 45 years, decimal visual acuity 
1.2. Normal fundus with corresponding normal 
FAF. The black crescent temporal of the optic disc 
on the FAF image is the pigment crescent that also 
can be seen on the colour fundus image. An image taken with FAF can show increased or 
decreased lipofuscin levels before any signs can be 
seen on a colour fundus image (Bindewald-Wittich et 
al, 2010). For example, before any pigment migration, 
typical in patients with retinitis pigmentosa (RP), is 
visible on a colour fundus image a ring of increased 
FAF can be seen around the fovea (Robson et al, 2010). In addition, FAF can be of help in detecting 
choroidal nevi at risk of developing into a malignant 
choroidal melanoma because the orange pigmentation, 
which has been defined as a risk factor by Shields et al 
(2009), gives an increased FAF that can be seen before 
it is visible on a colour fundus image. Most nevi will 
show normal AF (Lavinsky et al, 2010). Increased gathering of lipofuscin in the RPE is an 
indicator of the underlying pathological mechanisms 
of age-related macular degeneration (AMD) (Sapru-
nova et al, 2010). Pigment anomalies typical for AMD 
can be seen on a FAF. Hypopigmentation usually 
shows as decreased FAF, while hyperpigmentation is 
shown as an increased FAF image (Bindewald et al, 
2005). FAF can differentiate or distinguish between 
different types of drusen which is important in diag-
nosing AMD (Delori, 2010). Choudhry et al (2010), in 
their review of the literature, came to the conclusion 
that FAF imaging is useful in foreseeing the progres-
sion of geographic atrophy. Bird (2010) states that FAF 
imaging is helpful in choroidal neovascularization 
(CNV) because it can show if there are photorecep-
tors that are still functioning (a normal FAF) beneath 
the leakage. In such cases, treatment would give the 
patients a better outcome. Colour and FAF images of commonly seen condi-
tions are presented below. All our FAF images taken 
with the Canon CR-2 PLUS ( Figures 1 and 2 ) are 
discussed in relation to scientifically published reports 
on FAF findings in similar ocular conditions with 
other FAF cameras. However, this is not a scientific 
comparison between fundus photography and FAF, 
but a presentation and illustration of some commonly 
seen conditions. The images presented here were 
captured at the Open University Clinic, Unit of 
Optometry, Karolinska Institutet, Stockholm, Sweden 
and the Emergency room, St Erik Eye Hospital, Stock-
holm, Sweden. Informed consent was obtained from 
all subjects involved. Canon CR-2 PLUSTM
Normal FAF 
The normal fundus shows diffuse homogeneous 
FAF over most of the fundus. There are no lumps of 
FAF Filters
Excitation
wave
Exciter filter
530-580 nm
Emission
wave
Barrier filter
640 nm and more
Lipofuscin
excitation and emission
Emission
1.0
0.8
0.6
0.4
0.2
Wavelength (nm)nm
400  500   600  700   800  900400  450  500  550   600  650  700  
EXC BA
Figure 2. Fundus autofluorescence (FAF) filters of the CR-2 PLUS.