Diagnostic Imaging of Retinal Vasculature

Clinical Applications

• The American Academy of Ophthalmology recommends fundus fluorescein angiography (FFA) to evaluate the extent of vascular occlusions (retinal vein or artery occlusions) in patients with retinal disorders 1, 2
• FFA assesses the degree of retinal ischemia (ischemic vs. nonischemic) and identifies macular capillary nonperfusion that may explain vision loss in patients with retinal disease 1, 3
• The procedure distinguishes collateral vessels (no late leakage) from retinal neovascularization (shows late leakage) and detects areas of untreated retinal capillary nonperfusion that may explain persistent neovascularization 1, 4

Comparison with Other Imaging Modalities

• The American Academy of Ophthalmology notes that while optical coherence tomography (OCT) has become the primary tool for evaluating macular edema, FFA remains valuable for assessing vascular perfusion in patients with retinal disease 4
• Recent studies show that optical coherence tomography angiography (OCTA) is similar to FFA in detecting capillary nonperfusion and vascular abnormalities, but OCTA is currently limited by image artifacts and field of view 4

Safety Considerations

• The American Academy of Ophthalmology recommends that FFA be performed with informed consent, as it carries potential risks, including severe medical complications (approximately 1 in 200,000 patients) and rare adverse events such as anaphylaxis 1
• Each angiography facility should have an emergency care plan and protocol to manage risks and complications, and special considerations should be taken for pregnant women, as fluorescein crosses the placenta 1

Evolving Role in Clinical Practice

• The American Academy of Ophthalmology notes that FFA remains a valuable tool for ophthalmologists diagnosing and treating retinal vascular disease, despite the emergence of newer imaging technologies and treatments such as anti-VEGF agents and intraocular corticosteroids 1, 4