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Comparative Study
. 2013 Nov 1;44(6):536-43.
doi: 10.3928/23258160-20131105-04.

Comparison of fundus autofluorescence between fundus camera and confocal scanning laser ophthalmoscope-based systems

Sung Pyo Park, Frank S Siringo, Noelle Pensec, In Hwan Hong, Janet Sparrow, Gaetano Barile, Stephen H Tsang, Stanley Chang
Comparative Study

Comparison of fundus autofluorescence between fundus camera and confocal scanning laser ophthalmoscope-based systems

Sung Pyo Park et al. Ophthalmic Surg Lasers Imaging Retina. .

Abstract

Background and objective: To compare fundus autofluorescence (FAF) imaging via fundus camera (FC) and confocal scanning laser ophthalmoscope (cSLO).

Patients and methods: FAF images were obtained with a digital FC (530 to 580 nm excitation) and a cSLO (488 nm excitation). Two authors evaluated correlation of autofluorescence pattern, atrophic lesion size, and image quality between the two devices.

Results: In 120 eyes, the autofluorescence pattern correlated in 86% of lesions. By lesion subtype, correlation rates were 100% in hemorrhage, 97% in geographic atrophy, 82% in flecks, 75% in drusen, 70% in exudates, 67% in pigment epithelial detachment, 50% in fibrous scars, and 33% in macular hole. The mean lesion size in geographic atrophy was 4.57 ± 2.3 mm(2) via cSLO and 3.81 ± 1.94 mm(2) via FC (P < .0001). Image quality favored cSLO in 71 eyes.

Conclusion: FAF images were highly correlated between the FC and cSLO. Differences between the two devices revealed contrasts. Multiple image capture and confocal optics yielded higher image contrast with the cSLO, although acquisition and exposure time was longer.

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Conflict of interest statement

The authors have no proprietary or financial interest in the materials presented herein.

Figures

Figure 1
Figure 1
Calculation of geographic atrophy lesion area using Matlab software (Mathworks, Natick, MA). FAF images acquired using (A) confocal scanning laser ophthalmoscope (cSLO) and (C) fundus camera. Lesion borders were manually delineated. Atrophic lesion area in the same patient as calculated using (B) cSLO and (D) fundus camera images.
Figure 2
Figure 2
Geographic atrophy lesion size (mm2) for confocal scanning laser ophthalmoscope versus fundus camera.
Figure 3
Figure 3
Bland-Altman plot of geographic atrophy lesion area (mm2), measured with confocal scanning laser ophthalmoscope (cSLO) and fundus camera (FC) techniques, with the average lesion size for the two techniques on the x axis and the difference between cSLO and FC measurements for each lesion on the y axis.
Figure 4
Figure 4
Agreement of fundus autofluorescence (FAF) pattern between confocal scanning laser ophthalmoscope and fundus camera–based images of the same eye. FAF images were the same pattern in 86% of cases, with disagreement in 9% and inability to compare in 5%.
Figure 5
Figure 5
Fundus autofluorescence pattern agreement rates with respect to lesion subtypes: hemorrhage, 100%; geographic atrophy, 96.5%; flecks, 81.8%; drusen, 75%; exudates, 70%; pigment epithelial detachment, 66.7%; fibrous lesions, 50%; and macular hole, 33.5%
Figure 6
Figure 6
Imaging in age-related macular degeneration (AMD). (A–C) Color fundus, fundus camera (FC) fundus autofluorescence (FAF), and confocal scanning laser ophthalmoscope (cSLO) FAF images of drusen in nonexudative AMD. (D–F) Fundus color, FC FAF, and cSLO FAF images of a fibrovascular lesion in exudative AMD. The foveal aspect of the fibrous tissue lesion shows hyper and hypoautofluorescence with the FC (E) and hypoautofluorescence with the cSLO (F). In the peripheral aspect of the lesion, the fibrous tissue exhibits hyper- and hypoautofluorescence with both the FC and cSLO techniques (E–F).
Figure 7
Figure 7
Fundus images in a patient with STGD1 (A–C) and one with retinitis pigmentosa (D–F). (A, D) Color fundus images. (B, E) Fundus camera (FC) fundus autofluorescence (FAF). (C, F) Confocal scanning laser ophthalmoscope (cSLO) FAF. Both systems detect hypoautofluorescence indicative of atrophic regions and flecks (B–C). Foveal RPE mottling is imaged as a speckled pattern of isoautofluorescence and hypoautofluorescence with the FC, with uniform hypoautofluorescence with the cSLO (B–C, red circles). Choroidal vessels are visible in the FC but not cSLO FAF images (E–F, white arrows).
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