Fundus Autofluorescence

The retinal pigment epithelium (RPE) has many important functions including phagocytosis of the photoreceptor outer segments. The metabolism of the photoreceptor outer segments leads to the formation of lipofuscin. Disease states and potentially increased oxidative damage can lead to the buildup of lipofuscin in the RPE (Figure 1). When stimulated with a broad wavelength of light, lipofuscin autofluoresces (Figure 2). Excess accumulation of lipofuscin leads to hyperautofluorescence whereas death of absence of the RPE leads to the disappearance of lipofuscin and hypoautofluorescence (Figure 3). The primary methods of obtaining fundus autofluorescence images include confocal scanning laser ophthalmoscopy and modified fundus photography. A normal fundus autofluorescence image is shown in Figures 4 and 5 and case examples of bilateral central scotomas from a macular dystrophy (Figures 6 and 7), acute macular neuroretinopathy (Figures 8 and 9), bull's-eye maculopathy from chloroquine toxicity (Figures 10 and 11), and pseudopapilledema from optic disc drusen (Figures 12 and 13) are shown.