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Identifying the factors for improving quality of oral fluorescein angiography
  1. Manuel J Amador-Patarroyo1,2,
  2. Tiezhu Lin3,4,
  3. Amit Meshi5,
  4. Kunny C Dans1,
  5. Kevin Chen3,
  6. Shyamanga Borooah1,6,
  7. Nicolás Molano-Gonzalez7,
  8. Jorge A Díaz-Rojas8,
  9. William R Freeman3
  1. 1 Ophthalmology, Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, California, USA
  2. 2 Ophthalmology, Escuela Superior de Oftalmologia, Instituto Barraquer de America, Bogota, Colombia
  3. 3 Ophthalmology, Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
  4. 4 Ophthalmology, He Eye Hospital, He University, Shenyang, Shenyang, China
  5. 5 Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  6. 6 Department of Ophthalmology, Center for Clinical Brain Sciences, School of Clinical Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
  7. 7 School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
  8. 8 Department of Pharmacology, Science Faculty, Universidad Nacional de Colombia, Bogota, Colombia
  1. Correspondence to Dr William R Freeman, Ophthalmology, Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA; wrfreeman{at}


Aim To evaluate the quality of oral fluorescein angiography (FA) in relation to food intake.

Methods This is an observational, case-crossover study. We collected information from patients undergoing routine oral FA for retinal disease at the Shiley Eye Institute. Eighty patients (160 eyes) were analysed. Fasting and non-fasting images of the same patient were recorded, compared and analysed for different image quality parameters and clinical relevance by experienced retina specialists.

Results When analysing the images, intergrader agreement was moderate to good with a Kappa averaging 0.60 (0.5–0.85). When patients were fasting pre-imaging, better angiography quality scores were achieved when compared with images taken when patients were non-fasting (mean 0.84 vs 0.72, p<0.001). Multivariate analysis showed that non-fasting patients with higher body mass index had the worst scores. Other clinical parameters, such as staining of drusen, staining of disciform scars or central and peripapillary atrophy, were also significantly better during the pre-fasting exam (p<0.001). Oral FA was approximately 22% faster (time to fluorescein dye appearance) under fasting conditions than non-fasting (mean±SD, minutes, 18.7±6.9 vs 25.14±8.1, p<0.001).

Conclusion Fasting oral FA provided significantly better quality images as well as faster optimal imaging times when compared with non-fasting oral FA. By improving its overall quality, oral FA could be a useful adjunctive examination to optical coherence tomography (OCT) and OCT angiography in patients who require FA studies but who have difficult access or refuse an invasive procedure.

  • diagnostic tests/investigation
  • imaging
  • macula
  • pharmacology
  • physiology

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  • Contributors The study was conducted and completed in the Jacobs Retina Center at the Shiley Eye Institute, University of California San Diego, La Jolla, California. All the authors contributed equally to this work. Data collection, scientific input, manuscript elaboration and image grading were performed by MJA-P, TL, AM, KCD, KC, SB, FRCOphth and WRF. Scientific input, manuscript elaboration, methodology and biostatistics were performed by NM-G and JAD-R.

  • Funding This study was supported in part by a UCSD Vision Research Center Core Grant P30EY022589, an unrestricted fund from Research to Prevent Blindness, New York (WRF), and Foundation Fighting Blindness career development award (SB).

  • Disclaimer The funding organisation had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional Review Board approval from UCSD was obtained for the review of patients’ charts and images. The study adhered to the tenets of the Declaration of Helsinki for research involving human subjects and complied with the Health Insurance Portability and Accountability Act (HIPAA).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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