Fluorescein Angiography

In most cases, it is not necessary to be completely fasting for a fluorescein angiography, and it is actually preferable to have eaten a light meal to reduce the risk of vasovagal episode or nausea. However, it is advisable to avoid a very heavy meal just before the examination. If you are being monitored for a particular condition (pregnancy, heart or kidney failure, complex allergies), instructions may be tailored on a case-by-case basis by your ophthalmologist or general practitioner.

Right after the examination, vision is often blurred for a few hours due to pupil dilation and the bright light used for the photographs. It is therefore preferable not to drive immediately after a fluorescein angiography. Ideally, come accompanied or arrange transportation home, then wait until your vision is comfortable again before getting behind the wheel. Most patients feel comfortable again by the end of the day or the following morning.

A known allergy to fluorescein is an absolute contraindication and must be reported before the examination. In cases of significant allergic history (asthma, anaphylaxis, severe drug allergies), the angiography may still be possible with enhanced precautions, or may be replaced by alternative imaging depending on the situation. Moderate kidney failure is generally not a contraindication, as fluorescein does not use the same elimination mechanisms as certain contrast agents used in CT scans. In all cases, it is essential to mention your medical history (allergies, pregnancy, kidney or heart conditions) so that the approach can be safely adapted.

Macular OCT provides detailed cross-sectional images of the retina and primarily shows the architecture and thickness of the tissues. OCT angiography (OCT-A) visualizes certain blood flows without dye injection, which is very useful for monitoring. Fluorescein angiography, on the other hand, remains the gold standard for analyzing retinal capillary permeability, leaks, and areas of ischemia. It allows visualization of the dynamic passage of the dye over time, which remains irreplaceable in certain situations (complex forms of AMD, extensive venous occlusions, proliferative diabetic retinopathy, etc.). In practice, these examinations are complementary rather than competing.

Most patients mainly experience light sensitivity and blurred vision for a few hours due to pupil dilation. The yellowish discoloration of the skin and urine generally disappears within 24 hours, as the dye is eliminated. Nausea, when it occurs, is brief and resolves spontaneously without specific treatment. If more pronounced symptoms appear after the examination (skin rash, persistent malaise, breathing difficulties), you should promptly see a doctor or go to the emergency department to rule out a more significant reaction.

There is no standard schedule that applies to everyone. Fluorescein angiography is generally performed at the time of the initial diagnosis, then repeated only if the clinical situation warrants it: worsening vision, changes on OCT, suspected neovascularization, or new areas of ischemia. For routine follow-up, OCT and, if needed, OCT angiography are often sufficient and avoid repeated dye injections. Your ophthalmologist therefore recommends angiography only when the examination is likely to change the management plan (decision regarding injections, laser treatment, or change in therapeutic strategy).

During pregnancy, fluorescein angiography is generally avoided when another examination (OCT, OCT-A) can provide sufficient information. However, it may be considered on a case-by-case basis when there is a major visual concern, after discussion between the ophthalmologist, the referring physician, and the patient. During breastfeeding, the examination remains possible: as a precaution, it is sometimes recommended to pump and discard breast milk for 24 hours after the injection. In all cases, it is essential to inform the team that you are pregnant or breastfeeding before scheduling the examination.