Fundus Photography

Fundus Photography: Eye Examination by Ophthalmologist Vasileios Skouteris in Neo Psychiko

Fundus photography is a painless, quick and extremely useful diagnostic test that allows the ophthalmologist to look inside the eye and assess the health of the retina, the macula, the optic nerve and the blood vessels.

Page contents

1. Fundus Photography: Eye Examination by Ophthalmologist Vasileios Skouteris in Neo Psychiko
2. When Is Fundus Photography Needed?
3. How Is the Test Performed?
4. Why Choose Fundus Photography?
5. Book an Appointment Today
6. What does fundus photography show?
7. Do you need pupil dilation for fundus photography?
8. What is the fundus of the eye?
9. The different types of fundus photography
10. What fundus photography detects in each condition
11. Fundus photography, fundoscopy and OCT: what is the difference?
12. Fundus photography for people with diabetes
13. Choroidal naevi: why photography is needed
14. The examination step by step
15. Preparing for the examination
16. How the results are assessed
17. How often is fundus photography needed?
18. Fundus photography in children
19. What the eyes reveal about your general health
20. Myths about fundus photography
21. Questions worth asking after the examination
22. Why recording changes over time makes a difference
23. Frequently Asked Questions about Fundus Photography

At the practice of ophthalmologist Vasileios Skouteris, at 26A Agias Sofias Street, Neo Psychiko, fundus photography is carried out with modern high-resolution equipment, providing accurate and reliable results.

When Is Fundus Photography Needed?

The test is recommended in cases of:

• Diabetic retinopathy
• Age-related macular degeneration (AMD)
• Glaucoma
• High blood pressure
• Blurred or reduced vision
• Preventive screening after the age of 40

Fundus photography is a valuable tool for the early diagnosis and monitoring of many eye conditions.

How Is the Test Performed?

The procedure is simple and painless:

1. The patient sits in front of a special fundus camera.
2. If needed, dilating eye drops are used (for a clearer image).
3. A photograph of the fundus is taken within a few seconds.

No preparation is required and you can return to your daily activities straight away (unless drops are used, in which case vision returns to normal within 1-2 hours).

Why Choose Fundus Photography?

• Detection of early changes
• A record that can be compared with previous examinations
• A painless, safe and quick procedure
• Ideal for people with diabetes or high blood pressure, older adults and patients with a family history of eye disease

Book an Appointment Today

Regular eye examinations can prevent serious damage to your sight. Contact us to schedule your fundus photography examination.

What does fundus photography show?

Fundus photography records the back of the eye in high resolution. It allows the ophthalmologist to see and archive:

• The optic nerve head, where changes in shape and cupping associated with glaucoma can be seen.
• The macula, with findings such as drusen, pigment changes or haemorrhages in macular degeneration.
• The retinal blood vessels, with microaneurysms, haemorrhages and exudates in diabetic retinopathy, as well as changes caused by high blood pressure or vessel occlusions.
• Choroidal naevi and other lesions that need monitoring for possible change.
• The retinal periphery, when a wide-field camera is used.

The great value of the test lies in comparison over time. The photographs are stored, and at every follow-up visit it becomes clear whether a lesion has grown, remained stable or regressed. It is often combined with optical coherence tomography (OCT), which shows the layers of the retina in cross-section.

Do you need pupil dilation for fundus photography?

Not always. Modern non-mydriatic cameras can photograph through the pupil without drops, provided it is large enough in low light. Dilation is usually needed when:

• the pupil is small, which is common in older people or with certain medicines,
• a cataract makes the image hazy,
• the retinal periphery needs to be examined in detail,
• the photograph is taken together with a full dilated fundus examination or other tests.

Dilating drops take effect in about 20-30 minutes. For a few hours afterwards, usually 4-6, near vision is blurred and you are sensitive to light. It is therefore a good idea to bring sunglasses and not to drive until the effect wears off. If you have a history of angle-closure glaucoma or have been told you have a narrow angle, let the practice know before dilation.

What is the fundus of the eye?

The fundus is the inner back wall of the eye, as seen through the pupil. It contains the retina, which converts light into nerve signals, the macula, which is responsible for central and detailed vision, the optic disc, the point where the optic nerve leaves the eye towards the brain, and a network of arteries and veins.

The fundus is the only place in the body where a doctor can see blood vessels and nerve tissue directly, without any incision. This is why a fundus photograph gives information not only about the eyes but also about the health of blood vessels throughout the body, for example in diabetes and high blood pressure.

The different types of fundus photography

Colour photography

This is the basic form. It records the fundus in its natural colours and shows haemorrhages, exudates, drusen, naevi and the appearance of the optic disc. It is used for diagnosis and, above all, for comparison from one examination to the next.

Wide-field photography

Modern wide-field systems capture a large part of the retina in a single image, including much of the periphery. They are particularly useful in diabetic retinopathy, vessel occlusions and peripheral changes that do not show up on a standard photograph of the centre.

Red-free photography

With a green filter, blood vessels, haemorrhages and nerve fibres are seen with greater contrast. It helps to detect small changes and to assess nerve fibre damage in glaucoma.

Fundus autofluorescence

This records the natural fluorescence of certain substances in the retina. It is used in macular degeneration to monitor atrophy, in inherited retinal diseases and in central serous retinopathy. No injection is needed.

Fluorescein angiography

This is a series of fundus photographs taken after an intravenous injection of dye, showing how blood flows through the vessels of the eye and where there is leakage. It is performed when detailed information about the circulation is needed, for example before laser treatment.

What fundus photography detects in each condition

• Diabetic retinopathy: Microaneurysms, haemorrhages, exudates and new blood vessels. Photography is the cornerstone of screening in people with diabetes.
• Hypertensive retinopathy: Narrowing of the arteries, crossings where arteries compress the veins and, in severe high blood pressure, haemorrhages and swelling of the optic disc.
• Glaucoma: Increased “cupping” of the optic disc and small haemorrhages at its rim. Serial photographs show whether the disc changes over time.
• Macular degeneration: Drusen, pigment changes and areas of atrophy.
• Choroidal naevi: The “moles” of the eye. Photography records their size and appearance, so that any growth can be detected.
• Retinal vessel occlusions and macroaneurysms.
• Optic disc swelling: A sign that may be related to raised intracranial pressure and requires neurological investigation.
• Myopic changes: Thinning and atrophy of the retina in high myopia.

Fundus photography, fundoscopy and OCT: what is the difference?

Fundoscopy is the direct examination of the fundus by the doctor, using lenses and light. It is dynamic: the doctor can see the whole periphery and examine every area in three dimensions. Fundus photography does something fundoscopy cannot: it records the image permanently, so that it can be compared objectively with future examinations. Optical coherence tomography (OCT) shows the retina in cross-section, in other words in depth, and measures its thickness precisely.

The three tests complement each other. In a full assessment of the fundus, the ophthalmologist often combines them: looking with fundoscopy, recording with photography and measuring with OCT.

Fundus photography for people with diabetes

Diabetic retinopathy is one of the leading causes of sight loss in people of working age, and for a long time it causes no symptoms at all. Regular screening with fundus photography detects changes at an early stage, when treatment is most effective. For most people with diabetes and no changes, one check a year is enough, while if there are findings, checks become more frequent. During pregnancy, women with pre-existing diabetes need closer monitoring.

Choroidal naevi: why photography is needed

Choroidal naevi are common and the vast majority are harmless, just like moles on the skin. However, because on rare occasions a naevus can change, it needs to be recorded and monitored. Fundus photography is the most reliable way to see whether a naevus is growing or changing in appearance. If there are suspicious features, such as thickness, fluid over the lesion or orange pigment, photography is combined with OCT, autofluorescence and ultrasound, and the patient is referred to a specialist centre when necessary.

The examination step by step

1. Dilation, when needed: For most images, drops are used to widen the pupil. They start to work within 15 to 20 minutes. Some modern devices can take photographs without dilation, but the image is usually better with a dilated pupil.
2. Position: You sit in front of the camera and rest your chin and forehead on the support.
3. Fixation: You look at a small light. The operator focuses on the fundus.
4. Capture: A brief flash takes the photograph. A few images in different directions of gaze may be needed to cover a larger area.
5. Afterwards: For a few minutes you may see a coloured “afterimage” from the flash, which fades quickly. If your pupils were dilated, your vision will be blurred and you will be sensitive to light for a few hours.

Preparing for the examination

• Do not drive after the test if your pupils are dilated. Come with someone or use public transport or a taxi.
• Bring sunglasses for the journey home.
• If you wear contact lenses, bring their case, as you may need to remove them.
• Let us know if you have angle-closure glaucoma or have been told you have a “narrow angle”, as this affects the decision on dilation.
• Bring any previous fundus photographs, if you have them, for comparison.

How the results are assessed

The ophthalmologist examines the photograph under magnification and compares it with the findings of the clinical examination. He assesses the colour and margins of the optic disc, the calibre and course of the blood vessels, the macula and every area of the retina. In serial examinations, the photographs are placed side by side so that even the slightest change becomes visible. This comparison is often the most valuable information: a haemorrhage that has resolved, a naevus that has remained stable or an optic disc that has not changed in five years.

How often is fundus photography needed?

• Diabetes without changes: Usually once a year.
• Diabetes with changes: Every 3 to 6 months, depending on severity.
• Glaucoma or a suspicious optic disc: At diagnosis and periodically for comparison.
• Choroidal naevus: Initially after a few months and, if stable, once a year.
• Dry macular degeneration: At the doctor’s discretion, usually once a year.

Fundus photography in children

In children, fundus photography is not a routine test, but it is very useful in specific situations: suspected optic disc swelling, inherited retinal diseases, juvenile diabetes and recording findings that will be monitored over time. Modern cameras are fast, and most children of school age cooperate without difficulty. Find out more about paediatric ophthalmology.

What the eyes reveal about your general health

Quite often, a fundus photograph taken for vision-related reasons reveals a general health problem that had not been diagnosed. Narrowed arteries and characteristic vessel crossings may be the first sign of high blood pressure. Small haemorrhages and exudates may point to undiagnosed diabetes. Tiny white emboli inside an artery show that clots are travelling from the carotid arteries or the heart. A swollen optic nerve may mean raised pressure inside the skull.

In these cases, the ophthalmologist informs the patient and refers them to the appropriate doctor, with the photograph as documentation. In this way, fundus photography becomes a preventive tool for the whole body.

Myths about fundus photography

• “The flash damages the eyes.” The flash is bright but brief and completely safe. The afterimage that lingers for a few minutes is normal.
• “The photograph replaces the examination by the doctor.” The photograph is a record; the diagnosis is made by the ophthalmologist, based on the image and the clinical examination.
• “If I can see well, my fundus must be healthy.” Many fundus conditions, such as early diabetic retinopathy or glaucoma, do not affect vision in the early stages.

Questions worth asking after the examination

• Do the optic disc and the macula look normal?
• Are there any changes compared with the previous photograph?
• Do I also need OCT or another test?
• When should I have it repeated?

Why recording changes over time makes a difference

Memory, even that of the most experienced doctor, cannot compare precisely how an optic nerve or a naevus looked two years ago. A photograph can. This is why, in chronic conditions such as diabetes, glaucoma or macular degeneration, the first photograph is the “baseline” on which all future monitoring is built. Each new photograph adds another piece to the history of your eye health.

If you have had fundus photographs taken at another practice in the past, it is worth asking for a copy and bringing them with you. Even if they were taken with a different device, comparing the images is valuable.

A simple system helps a great deal: keep all your eye test results in one folder, with dates, and bring it to every visit. That way the doctor has the full history of your eyes in front of him and can make safer decisions about treatment and about the schedule of your next check-ups. The same applies to OCT scans, visual fields and old spectacle prescriptions, which often provide useful information about how your vision and eye health have changed over the years.

To book a fundus photography appointment, call 210 677 0007.

Frequently Asked Questions about Fundus Photography

Medically reviewed by: Dr. Vasileios Skouteris MD, FEBO