Step-By-Step Fundus Photography and Fluorescein Angiography
Plan the procedure
- Review patient records including: ocular diagnosis, allergies, pregnancy status, systemic diseases.
- Review photographic request, confirm area of interest.
- Plan the photographic procedure.
Prepare the patient
- Confirm adequate dilation.
- Inform patient of procedures, pharmacologic agents to be administered, and potential side effects.
- Answer patient questions concerning the procedure.
- Position patient for photography.
Prepare the camera
- Enter patient demographic information into capture software or photograph patient ID.
- Set eyepiece for accommodative correction.
- Select camera back.
- Set viewing angle.
- Set flash power.
- Set viewing light.
Perform Fundus Photography
- Establish fixation with external or internal fixation device.
- Use joystick to align illumination beam within pupil.
- Focus on designated field of view.
- Use astigmatic correction device if available/needed.
- Take color photographs of required area of interest.
- Use lateral shift of joystick to obtain sequential stereo pairs.
- Review images for quality, correct artifacts and adjust settings accordingly.
- Switch camera back/adjust settings for monochromatic green (red-free) photos.
- Engage green filter.
- Set flash power.
- Take monochromatic green photographs of required area of interest.
- Use lateral shift of joystick to obtain sequential stereo pairs.
Perform Fluorescein Angiography
- Make preparations for IV fluorescein injection.
- Switch camera back/ adjust settings for fluorescein angiography.
- Engage exciter and barrier filters.
- Set flash power.
- Position patient for procedure (with arm extended).
- Establish fixation with external or internal fixation device.
- Use joystick to align illumination beam within pupil of eye of interest.
- Focus on designated field of view.
- Take a control photograph to confirm absence of pseudofluorescence.
- Cue injector to begin.
- Start timer concurrent with the administration of dye.
- Begin pre-planned photographic sequence.
- Early transit capture rate of one frame per second of posterior pole or area of interest until about 40 seconds.
- Use lateral shift of joystick to obtain sequential stereo pairs.
- Capture posterior pole photos of fellow eye.
- Follow with peripheral survey fields of transit eye if necessary.
- Monitor and assess the patient’s response to the procedure.
- Respond to any adverse reactions experienced by the patient.
- Perform mid-phase photographs of posterior pole at 2-4 minutes post injection.
- Perform late phase photographs at 7-10 minutes post injection increase flash setting or camera gain settings for adequate late exposure.
For more on fluorescein angiography, visit:
Fundamentals of Fluorescein
Equipment & Technique
Interpretation