Fundus with soft drusen. The FAF shows a mottled 
pattern all over the image, typical for AMD. Figure 9. Male, 86 years, decimal visual acuity 
0.1. Geographic atrophy due to dry AMD. There is 
hypofluorescence (dark grey on the image) from 
the atrophic RPE area. hypo- or hyper-fluorescence and the fovea appears 
darker than the surrounding tissue. Around the fovea 
the FAF is not symmetrically distributed, it seems 
to be brighter nasal to the fovea. The optic disc and 
the blood vessels are darker than the other structures 
(Figures 3, 4 and 5). Age-related macular changes
Age-related macular changes are common causes 
of visual loss. The transformation from normal age-
related changes such as drusen to AMD is not fully 
understood. The possibility of detecting early RPE 
changes, through the use of FAF, could help us to 
better understand these processes and detect patients 
at risk of developing sight threatening conditions. Age-
related changes can manifest themselves in different 
ways depending on the severity and type. Examples 
from different stages of age-related macular changes 
can be seen in the images below. The changes are in 
some cases more obvious on the FAF image (Figure 6) 
and in some cases more obvious on the colour fundus 
image (Figure 7). The size and location of the drusen 
on the colour fundus image does not necessarily corre-
spond to the FAF ( Figure 8). Geographic atrophy is 
presented as black/dark grey because the RPE tissue is 
atrophic, thus hypofluorescent (Figure 9). Three cases 
of neovascular AMD are shown and no typical pattern 
can be recognized (Figure 10). Choroidal nevus
Choroidal nevi are frequently observed in otherwise 
healthy subjects (5–10%) and they rarely transform 
into melanoma (Shields et al, 2009). Although several 
risk factors predicting such transformation have been 
identified, it is often difficult to distinguish a nevus 
from a melanoma when using only colour fundus 
images. Below follows some examples of the FAF 
appearance in cases with hyperpigmentation, nevi and 
one melanoma (Figures 11, 12, 13 and 14). For further 
information see the discussion. Diabetes
Microvascular changes like micro aneurysms, haemor-
rhages, cotton wool spots and hard exudates are asso-
ciated with diabetic retinopathy (Fong et al, 2003). On 
FAF images haemorrhages appear dark, because the 
blood absorbs the light (Figure 15). In one of the cases 
below, with cotton wool spots, the FAF shows find-
ings that are more pronounced than in the coloured 
image (Figure 16 ). Hard exudates and oedema are 
not necessarily as pronounced on the FAF images as 
seen in Figure 17. Scars after laser treatment are very 
pronounced on the FAF (Figure 18). Epiretinal membrane
Epiretinal membranes are relatively common in 
elderly persons and have been associated with ocular