![]() It’s now not only possible to assess more peripheral findings in diseases like diabetic retinopathy and macular degeneration, but these systems also allow for imaging and evaluation of choroidal masses, retinal vasculitis, choroidal dystrophies, hereditary retinal disorders and retinal vein occlusions outside the normal limited window of capture in standard fundus photography. Ultra-widefield imaging allows for imaging of 80 percent or more of the retinal surface area through a 200-degree retinal view. As the peripheral retina is the site of pathology in many retinal diseases, widefield fundus photography has proved transformational for early screening, diagnosis and monitoring of an expanded list of retinal diseases. With the invention of widefield and ultra-widefield fundus imaging systems such as the non-contact tabletop Zeiss Clarus (Carl Zeiss Meditec AG Jena, Germany) and Optos Daytona (Optos PLC Dunfermline, United Kingdom), it’s become possible to quickly gather high-resolution information beyond the posterior pole. Standard color fundus images can be useful if there’s a need to capture high-magnification images of the macula in the clinic or to get a true-to-scale, color image of the optic nerve. Thirty-degree images just barely capture both the optic disc and macula in one image. ![]() However, these images are limited in their scope and are largely falling by the wayside in favor of widefield fundus imaging that allows for visualization of the retinal periphery, not just the macula and optic disc. These 20 to 50 degree images can be acquired rapidly and provide painless, reproducible, and high-resolution views that are true to size and color. Standard color fundus photography continues to allow for the documentation of posterior pole findings including the macula and optic disc. This old standby has gone through several iterations in recent years that have increased its versatility and usefulness. ![]() It’s important to keep in mind that many of these imaging techniques and technologies are used in conjunction with each other to gain a fuller understanding of the extent of pathology in a given patient. In this article we’ll explore a number of current retinal imaging modalities and their broadened utilities. Additionally and importantly, the capture of clear retinal images allows for unambiguous communication between physicians and contributes to the education of trainees. Well-captured retinal images allow us to identify disease severity and stage, compare follow-up visit images to documented findings, track progression of disease between visits, and screen for pathology early. Better fields of view, image clarity/detail and modes of acquisition not only help during diagnosis of retinal disorders but also during screenings and follow-ups. The clinical utility of these imaging techniques is constantly expanding, with new developments in machinery allowing for improvements in patient care. But when RPE cells die or are absent, LF disappears, leading to hypofluorescence.A dvances in retinal imaging modalities allow us to visualize posterior segment findings to a previously unmet degree. Areas of excess Lipofuscin accumulation will appear hyperfluorescent. FAF imaging can visualize the deposition of lipofuscin in the retinal pigment epithelium (RPE). Lipofuscin deposition normally increases with age, but may also occur from RPE cell dysfunction or an abnormal metabolic load on the RPE. Lipofuscin is a fluorescent pigment that accumulates in the RPE as a metabolic byproduct of cell function. This naturally occurring fluorescence is mainly caused by Lipofuscin. Since the introduction of fluorescein angiography (FFA) in 1959, ophthalmologists observed that even without the use of fluorescein, parts of the fundus would show areas of faint fluorescence under certain conditions. It can be a valuable asset in diagnosing retinal disease. ![]() It is easy and non invasive and provides information that may otherwise not be clinically detectable. A diagnostic technique for documenting the deposition of lipofuscin in the retinal pigment epithelium (RPE).
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