Stephen expressed the reason for the 20 second exposure perfectly. We had to do
this in the protocol of a clinical trial. It gives more accurate and repeatable
measurements I believe.
P
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On Apr 6, 2021, at 9:48 AM, Stephen Travers <StephenPTravers@xxxxxxxxxxx>
wrote:
The purpose of exposing the retina for 20 seconds prior to capturing an
Autofluorescence image was to bleach the photoreceptors. This would have the
effect of providing a uniformly exposed background retina and allow the
fluorophores the be visualized at their peak fluorescence on the resulting AF
image. This was of particular importance during the capture and analysis and
quantification of the resulting fluorescence intensity. This process was
recommended by Delori et al during qAF clinical studies when using the cSLO
Spectralis, ( see attached paper ). As the process is essentially to bleach
the retina, I would expect that capturing a color photo on any device before
AF imaging would have some positive effect by increasing the contrast of any
follow up Autofluorescence image.
As the issue seems to suggest that these poor-quality images referred to were
captured with a Fundus camera I would have to question if media opacities or
dilation or perhaps the spectral wavelength or filters were a contributing
factor. Some examples of these poor quality would be of interest.
Stephen Travers
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Sent: Tuesday, April 6, 2021 6:23 AM
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Subject: [optimal] Re: [External] Re: FAF before colors
Anything in the literature to support this idea? I haven’t noticed a
difference whether before or after with Optos. I’ll often do colors first on
the right eye and FAF first on the left, just because it’s faster workflow….
On a fundus camera system, I haven’t noticed it on there either, but over the
years I’ve typically done the colors first. Not sure what they mean by
“washed out”.
Tim 1
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Subject: [optimal] Re: [External] Re: FAF before colors
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They are talking about single images taken on Optos or fundus camera. Not an
averaged image like the Spectralis.
Thanks,
Tim Steffens
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Tim,
Trying to understand what the docs meant by "washed out". Does it mean a flat
(low contrast) image or an image that photogs may call overexposed?
Perhaps the sensitivity dial being set too high, or the capture time going
too long could give the FAF a "washed out" appearence....
Gary
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Subject: [External] [optimal] Re: FAF before colors
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Hi Tim,
"with the Spectralis, we let the light expose the lipofusin for 20 seconds
before we take the image" Are you saying that you expose the pt to that
bright FA/FAF light for 20 sec, and then take the FAF? I have never done
this, and I'd like to think our patients are grateful for that! Also, I do
try to always get FAF prior to colors, to avoid the Zeiss circle or
Spectralis rectangle bleach mark.
Sean Grout
UNC Kittner Eye Center
Chapel Hill, NC
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Hi all,
I have two docs requesting FAFs before colors because they were at virtual
conference and heard that FAF can be washed out even when obtained after a
color photo. This came from Vas Sadda, chair at USC. Has anyone heard of
this? I know with the Spectralis, we let the light expose the lipofusin for
20 seconds before we take the image because then the lipofusin is at its peak
emission. We can’t do that with a fundus camera or LSO (Optos) because it a
single capture, the light is not constantly on. I would think that exposing
the retina to blue or green light (488 or 540nm) would help saturate the
lipofusin to emit more fluorescence or closer to peak fluorescence. Comments?
Thanks,
Tim Steffens
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<Delori - Quantitative Measurements of Autofluorescence with the Scanning
Laser Ophthalmoscope - IOVS 2011.pdf>
