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Fluorescein Angiography (FFA): The Dye Test That Shows Your Retina's Blood Vessels
Fluorescein angiography is an eye test in which a harmless yellow dye is injected into a vein in your arm and a special camera photographs the dye as it flows through the blood vessels at the back of your eye. It shows leaking, blocked or abnormal vessels that an ordinary eye examination cannot, so it helps your surgeon decide whether you need treatment for the retina, and which. At Laser Istanbul Clinic it is requested when your retina surgeon needs to see blood flow, and your surgeon explains the pictures with you.
Fluorescein angiography (FFA, or FA) is a retinal imaging test. Fluorescein dye is injected into an arm vein and reaches the eye in about 10 to 15 seconds, and a camera takes photographs as it fills the retinal vessels. The test is typically completed in under 30 minutes. It is used to diagnose and plan treatment for macular degeneration, diabetic eye disease and retinal vein blockage. Doç. Dr. Muhammet Derda Özer and Op. Dr. Aysan Bayram read retinal angiograms.
What is fluorescein angiography and what does the dye do?
Fluorescein angiography is a photographic test of the blood supply of the retina, the light-sensitive layer at the back of the eye, and of the layer of vessels beneath it, the choroid. The American Academy of Ophthalmology (AAO) describes it as a test in which the ophthalmologist uses a special camera to take pictures of your retina.
The test works because of the dye. Fluorescein is a yellow dye that glows (fluoresces) when blue light shines on it. The camera uses a blue flash and a filter so that only the glowing dye shows up in the picture. Healthy vessels hold the dye inside them and appear as a clean, sharply outlined network. Damaged vessels look different: they may leak dye into the retina, be blocked so the dye cannot enter, or be new, abnormal vessels that were not there before. No X-rays or radioactive materials are used.
Fluorescein angiography is often called FFA (fundus fluorescein angiography), FA, or simply an "eye angiogram". All the names mean the same test. It should not be confused with OCT angiography, a different, dye-free scan described below.
What is fluorescein angiography used for? Indications
Your surgeon requests an FFA when there is a question about blood flow, leakage or new vessel growth in the retina that a normal examination or an OCT scan has not fully answered. The AAO lists the following conditions that fluorescein angiography helps identify:
- Age-related macular degeneration (AMD), especially the "wet" form with abnormal new vessels
- Diabetic retinopathy and diabetic macular oedema (swelling of the central retina)
- Retinal vein occlusion, a blockage in the veins that drain the retina (branch or central)
- Macular oedema from other causes
- Macular pucker (a membrane on the surface of the macula)
- Ocular melanoma (a tumour inside the eye)
EyeWiki, the AAO's clinical wiki, adds choroiditis (inflammation of the choroid), Stargardt's disease and drusen to the list of conditions that show up on the test. It also notes that fluorescein angiography is used to track how a disease progresses and to target treatment.
Fluorescein angiography indications by condition
| Condition | What the AAO says FFA is used for |
|---|---|
| Wet AMD | To find the presence, extent, type, size and location of abnormal new vessels (macular neovascularisation); to guide treatment; to detect persistent or recurrent vessels after treatment |
| Diabetic eye disease | To tell diabetic macular oedema apart from other macular disease; to investigate unexplained vision loss; to show areas of lost blood supply (capillary non-perfusion) |
| Retinal vein occlusion | To show how much of the vessel is blocked, how poor the blood supply is (ischaemia) and how extensive the macular swelling is |
| Unexplained blurred vision | To look for a cause when the examination does not explain the loss of sight |
When is FFA not needed?
The AAO's retina benchmarks state that fluorescein angiography is not part of the regular examination of people with diabetes. Many patients have a retinal check, photographs and an OCT scan and never need an angiogram. It is requested when the answer will change what is done next, not as a routine test.
Why you may need FFA before retinal treatment
A retinal angiogram is a planning tool. A surgeon deciding between injections into the eye, retinal laser or surgery needs to know exactly where vessels are leaking or closed. The AAO's age-related macular degeneration guidance says fluorescein angiography is indicated to guide treatment, and to detect persistent or recurrent abnormal vessels after treatment. For diabetic eye disease the same guidance notes it can explain vision loss that does not respond to treatment, and can reveal areas of untreated capillary non-perfusion that may explain persistent new vessel growth after previous laser.
For overseas patients there is a practical reason too. If you already have a diagnosis, such as wet AMD or a vein occlusion, and you send us your reports and scans, we can tell you whether a repeat angiogram is likely to be needed before treatment, so that the plan is clear before you travel.
Fluorescein angiography procedure: what to expect step by step
The following steps combine the AAO's description with hospital eye-clinic leaflets from the NHS (Moorfields Eye Hospital, Gloucestershire Hospitals and Dudley Group NHS trusts).
Before the test
- You can usually eat and drink normally and take your medicines as usual. The Moorfields leaflet says so; the Dudley leaflet suggests avoiding a heavy meal beforehand. Your coordinator confirms the instructions for your appointment.
- Tell the team about allergies, especially to shellfish, iodine or fluorescein, and about asthma, heart or breathing problems, kidney dialysis, photosensitive epilepsy, and any chance that you are pregnant or are breastfeeding. Bring a list of your medicines and your glasses.
- Arrange to travel with someone, and bring sunglasses. Your pupils will be dilated.
During the test
- Your vision is checked and your health history is reviewed. Consent is explained and you can ask questions.
- Eye drops dilate your pupils. This takes around 30 minutes to work, according to NHS leaflets.
- You sit at the camera, with your chin on a rest and your arm supported. A first set of photographs is taken before any dye is injected.
- A small tube (cannula) is placed in a vein in your arm or the back of your hand.
- The dye is injected. According to the AAO it reaches the blood vessels of the eye in about 10 to 15 seconds. Moorfields notes you may feel a hot flush as the dye goes in.
- A rapid series of flash photographs is taken while the dye enters and fills the retinal vessels. You are asked to hold your eye still and look where the photographer asks. The flash is bright but painless.
- Later pictures are taken over the next several minutes to see whether the dye leaks or pools.
How long does fluorescein angiography take? The AAO says the test is typically completed in under 30 minutes. The Moorfields leaflet gives 10 to 30 minutes for the test itself and asks patients to allow one to two hours in the department for checks before and after. The Dudley leaflet likewise gives 20 to 30 minutes for the test and about 2 hours for the visit.
After the test: staff may keep you waiting briefly (15 minutes in one NHS leaflet) to be sure that you feel well. Your surgeon then goes through what the images show.
Fluorescein angiography aftercare: the first 24 to 48 hours
Aftercare is simple, but a few effects surprise people if they are not warned.
| Effect | What happens | How long it lasts |
|---|---|---|
| Blurred vision and light sensitivity | Caused by the dilating drops, not the dye | Several hours; Moorfields says near vision can be blurred for five to six hours |
| Yellow skin | A slight yellow tinge | Returns to normal within hours (AAO); a day or two (NHS leaflets) |
| Bright yellow or orange urine | The kidneys clear the dye | Up to 24 hours (AAO); one to two days (Moorfields, Gloucestershire) |
| Yellowish tinge to vision | Dye in the blood | Briefly, usually minutes (AAO) |
| Higher blood sugar readings | Dye can temporarily affect readings if you have diabetes | Temporary (Gloucestershire leaflet) |
Driving: do not drive or operate machinery until your pupils have returned to normal size (Dudley leaflet), and arrange a lift home.
Seek urgent help if you develop skin blotches, irritation or breathing difficulty after the test; the Gloucestershire leaflet says to go to the nearest emergency department immediately. Allergic reactions are rare, and staff keep you under observation for the period when they are most likely.
What do the images show? How an FFA is read
An FFA is a series of photographs taken in seconds, so the timing of each picture matters as much as the picture itself. EyeWiki describes the phases as follows.
| Phase | Approximate time after injection | What your surgeon sees |
|---|---|---|
| Choroidal flush | 8–12 seconds | The deeper layer of vessels beneath the retina begins to fill |
| Retinal circulation appears | 11–18 seconds | Dye enters the retinal vessels |
| Peak fluorescence | About 30 seconds | The vessel network is at its brightest and clearest |
| Recirculation | 3–5 minutes | Dye returns in a weaker second pass |
| End of the study | About 10 minutes | Late leakage or staining is checked |
The surgeon looks for two patterns:
- Hyperfluorescence (too bright): dye leaking out of fragile vessels, dye staining tissue, dye pooling in fluid-filled spaces, or "window defects" where the pigment layer is thin. Leakage is a sign of incompetent vessels or swelling.
- Hypofluorescence (too dark): areas where dye cannot be seen, either because something blocks the view (blood, for example) or because the vessels are blocked, as in a retinal vessel occlusion.
Your surgeon reads these patterns together with your examination and OCT scan. No single image gives a diagnosis on its own.
Optional media: {{short patient explainer video of an FFA, with a transcript}}
Fluorescein angiography side effects and safety
Is fluorescein angiography safe? It is widely used and generally well tolerated, but it is an injection, so side effects can occur. The most common are short-lived: nausea, sometimes vomiting, a warm flush and the yellow discolouration described above.
How often side effects occur depends on the study:
- In a prospective study of 2,789 angiograms in 2,025 patients (Kwiterovich and colleagues, Ophthalmology, 1991), adverse reactions followed 4.8% of procedures: nausea 2.9%, vomiting 1.2%, flushing, itching or hives 0.5%, and other reactions such as breathlessness or fainting 0.2%. There were no severe reactions in that study.
- The Moorfields leaflet advises that about one in ten patients might feel nauseous, short of breath or develop a brief rash, which rarely lasts more than a few seconds.
- Serious reactions (anaphylaxis, cardiac arrest, bronchospasm) are rare. EyeWiki quotes a death rate of about 1 in 221,781 procedures.
Anyone who has had a reaction before is at higher risk: in the Kwiterovich study the reaction rate on a repeat test was 48.6%, against 1.8% in patients who had tolerated a previous test. Tell your surgeon about any earlier reaction.
Other points to tell the team about:
- Pregnancy: EyeWiki states that no serious adverse events have been reported in pregnancy, but the test is considered a contraindication. Tell us if you are or may be pregnant.
- Breastfeeding: NHS leaflets ask you to tell the nurse if you are breastfeeding, so the team can advise on your situation.
- Allergy and asthma: the Moorfields leaflet says the test is used cautiously in patients allergic to shellfish or seafood.
- Photosensitive epilepsy: Moorfields notes that in rare instances flash photography may trigger a seizure.
- Diabetes: blood sugar readings may be temporarily higher.
The AAO states that every angiographic facility should have a care plan for emergencies and a clear protocol to minimise and manage complications.
Fluorescein angiography vs OCT and OCT angiography
Most patients having an FFA also have an OCT scan, and the two answer different questions. The AAO describes OCT as a non-invasive test using light waves to take cross-section pictures of the retina, letting the surgeon see its layers and measure their thickness. OCT shows structure; FFA shows blood flow and leakage.
OCT angiography (OCTA) is a newer, dye-free scan that maps blood flow. According to Fayed and Fawzi (Review of Ophthalmology, 2019), OCTA avoids the dye, shows the retinal capillary layers separately, and is not obscured by leakage. Fluorescein angiography still shows a much wider area of the retina and choroid, is more sensitive to low-flow lesions such as microaneurysms, and captures leakage over time, which static OCTA images cannot. The AAO says OCTA has not replaced other angiographic methods in macular degeneration.
| FFA | OCT | OCT angiography | |
|---|---|---|---|
| Needs an injection | Yes | No | No |
| Shows | Blood flow, leakage, blocked vessels | Cross-section structure and thickness | Blood flow in separate capillary layers |
| Best for | Leakage, wide-field blood supply, unexplained vision loss | Swelling, fluid, retinal layers | Capillary detail without dye |
The right combination depends on your condition. Your surgeon decides which tests you need.
Fluorescein angiography on the NHS and abroad
Fluorescein angiography on the NHS is carried out in hospital eye clinics when an ophthalmologist asks for it. The leaflets quoted above come from NHS trusts, and they show how a routine appointment works: dilating drops, a cannula, a series of photographs, and results either on the day or at your next appointment. Gloucestershire Hospitals NHS Foundation Trust, for example, tells patients that provisional results may be given straight away, otherwise at the next outpatient appointment, and that urgent findings are phoned to the patient.
If you already have NHS or private angiograms, our surgeons can review them first. If a new angiogram is needed, it can be done as part of your pre-operative examination in Istanbul.
Fluorescein angiography cost
Fluorescein angiography is part of the pre-operative examination and scans that are included in the price of treatment at Laser Istanbul Clinic whenever your retina surgeon requests it. If you only want an angiogram and a retina assessment, for example a second opinion before deciding on injections or surgery, a standalone retinal examination with FFA costs {{£ price for a standalone retinal examination with FFA}}. The price includes your surgeon's review, your personal interpreter and follow-up by your coordinator.
Hotel and airport transfers are not included and are a separate charge if you would like us to arrange them. Flights are not included.
If you are comparing "eye angiography cost" figures, check what each price covers: the dye and camera work, the specialist's report and the consultation are sometimes charged separately.
You can send recent angiograms, OCT scans and reports from your own clinic for a free initial review before you decide to travel.
Who reads your angiogram
Your pictures are read by the surgeon who will treat you. Doç. Dr. Muhammet Derda Özer (Doç. is the Turkish title for Associate Professor) is our retina specialist, with a focus on medical and surgical retina, uveitis and ocular oncology, so he reviews angiograms for retinal vascular disease, inflammation or an intraocular tumour. Op. Dr. Aysan Bayram, a female surgeon who speaks English, also treats retinal disease. If you have a cataract as well as a retinal problem, Prof. Dr. Ahmet Satıcı can plan your lens surgery with the retinal findings in mind.
Your surgeon explains what the images show and which options are open to you, through your interpreter if you wish.
Treatments fluorescein angiography supports
| Condition or treatment | How FFA is used |
|---|---|
| Wet AMD and other macular disease | Locates abnormal vessels and leakage; guides treatment; checks for recurrence |
| Diabetic retinopathy and macular oedema | Explains unexplained vision loss; maps areas of lost blood supply |
| Retinal vein occlusion | Shows the extent of blockage, ischaemia and macular swelling |
| Retina surgery: vitrectomy and retinal detachment | Part of retinal assessment when the cause of vision loss needs to be clarified |
Other tests in your eye examination
An angiogram is rarely the only test. Each of these answers a different question:
- OCT scan (optical coherence tomography): cross-section scans of the retina (/en/eye-tests-diagnostics/oct-scan/)
- Eye ultrasound (B-scan): imaging when the inside of the eye cannot be seen directly (/en/eye-tests-diagnostics/eye-ultrasound/)
- Visual field test (perimetry): checks your side vision (/en/eye-tests-diagnostics/visual-field-test/)
- Tonometry (eye pressure measurement): eye pressure, important for glaucoma checks (/en/eye-tests-diagnostics/tonometry/)
- VEP & ERG electrophysiology tests: electrical responses of the retina and visual pathway (/en/eye-tests-diagnostics/vep-erg-tests/)
- Corneal topography: a map of the front of the eye (/en/eye-tests-diagnostics/corneal-topography/)
Fluorescein angiography: frequently asked questions
Fluorescein angiography is an eye test in which a yellow dye is injected into a vein and a special camera photographs the dye as it passes through the blood vessels of the retina. It shows leakage, blockages and abnormal new vessels that cannot be seen on a normal examination.
It is used to diagnose and plan treatment for wet macular degeneration, diabetic retinopathy and macular oedema, retinal vein occlusion and other retinal vessel disease, and to look for the cause of vision loss that an examination does not explain. It is also used to follow disease and to see whether treatment is working.
Typical indications are new distortion or unexplained blurring of vision, macular swelling, fluid or bleeding under the retina, suspected abnormal new vessels, and checks for persistent or recurrent disease after treatment. The AAO notes it is not a routine test for everyone with diabetes.
The AAO says the test is typically completed in under 30 minutes, and NHS leaflets give 10 to 30 minutes for the photography. Allow one to two hours in total because of the time the dilating drops take to work.
The common ones are nausea, occasionally vomiting, a warm flush, yellow skin and bright yellow urine. In one large study 4.8% of procedures were followed by a reaction, mostly nausea. Serious allergic reactions are rare. Tell the team about previous reactions, allergies and asthma beforehand.
The kidneys clear the dye through the urine, turning it bright yellow or orange. The AAO says this can last up to 24 hours; NHS leaflets say one to two days. Your skin may look slightly yellow for a few hours to a day or two. Both effects fade on their own.
Not straight away. The dilating drops blur your vision for several hours, so arrange a lift home. NHS guidance is not to drive or use machinery until your pupils have returned to their normal size.
It is considered a contraindication in pregnancy, although EyeWiki notes no serious adverse events have been reported. Tell us if you are or may be pregnant. If you are breastfeeding, tell the nurse so the team can advise you.
No. OCT is a dye-free scan that shows the structure of the retina in cross-section. Fluorescein angiography shows blood flow and leakage. They are often used together, because each shows something the other cannot.
Yes. NHS hospital eye clinics carry out fluorescein angiography when an ophthalmologist requests it. If you are weighing a second opinion abroad, send your angiograms and reports and our surgeons will review them.
It is part of the pre-operative scans included in our treatment prices when your retina surgeon requests it. A standalone retinal examination with FFA costs {{£ price for a standalone retinal examination with FFA}}. Hotel and transfers are extra.
Sources for the facts on this page
- American Academy of Ophthalmology, What Is Fluorescein Angiography?: procedure steps; dye reaches the eye in about 10–15 seconds; typically under 30 minutes; conditions diagnosed (macular oedema, diabetic retinopathy, macular degeneration, retinal vein occlusion, macular pucker, ocular melanoma); yellow skin within hours and urine up to 24 hours; allergic reactions rare; bring sunglasses and arrange transport. https://www.aao.org/eye-health/treatments/what-is-fluorescein-angiography
- EyeWiki (AAO), Fluorescein Angiography: angiogram phases and timings (choroidal flush 8–12 s; retinal circulation 11–18 s; peak about 30 s; recirculation 3–5 min; end about 10 min); hyper- and hypofluorescence; conditions seen (choroiditis, Stargardt disease, drusen); severe-reaction mortality 1 in 221,781; pregnancy considered a contraindication, no serious events reported. https://eyewiki.org/Fluorescein_Angiography
- American Academy of Ophthalmology, Preferred Practice Pattern Summary Benchmarks: Retina/Vitreous (2025 edition as displayed on the page): FFA indications in AMD; not indicated as part of the regular examination of people with diabetes; useful for unexplained vision loss and to show capillary non-perfusion; use in retinal vein occlusion; OCTA has not replaced other angiographic methods in AMD; every angiographic facility should have an emergency care plan. https://www.aao.org/summary-benchmark-detail/retina-summary-benchmarks-2020
- Gloucestershire Hospitals NHS Foundation Trust, Fluorescein and indocyanine green angiography (GHPI0497, reviewed January 2025): no X-rays or radioactivity; tell staff about asthma, allergies (shellfish, iodine), pregnancy, breastfeeding; urine and skin yellow for 1–2 days; blood sugar readings may be temporarily higher in diabetes; wait 15 minutes afterwards; results on the day or at next appointment; urgent findings phoned; emergency care for skin blotches or breathing problems. https://gloshospitals.nhs.uk/documents/22640/Fluorescein_and_indocyanine_green_angiography_GHPI0497_01_25.pdf
- The Dudley Group NHS Foundation Trust, Fundus Fluorescein Angiography (FFA) patient information (FFA/JP/ST/DP/09 2024/V5): 20–30 minute test, about 2 hours in total; avoid a heavy meal; do not drive until pupils return to normal. https://www.dgft.nhs.uk/pil/fundus-fluorescein-angiograph/
- Kwiterovich KA, Maguire MG, Murphy RP, et al. Frequency of adverse systemic reactions after fluorescein angiography: results of a prospective study. Ophthalmology 1991: 2,789 procedures, 2,025 patients; 4.8% adverse reactions (nausea 2.9%, vomiting 1.2%, flushing/itching/hives 0.5%, other 0.2%); no severe reactions; repeat reaction 48.6% vs 1.8%. https://pure.johnshopkins.edu/en/publications/frequency-of-adverse-systemic-reactions-after-fluorescein-angiogr-4/
- Fayed AE, Fawzi AA. OCTA vs. Dye: The Pros and Cons. Review of Ophthalmology, 5 January 2019: what FFA shows that OCTA does not (wide field, low-flow lesions, leakage over time) and the reverse. https://reviewofophthalmology.com/article/octa-vs-dye-the-pros-and-cons
- American Academy of Ophthalmology, What Is Optical Coherence Tomography?: OCT uses light waves to take cross-section pictures of the retina. https://www.aao.org/eye-health/treatments/what-is-optical-coherence-tomography
Have retinal scans already? Let a surgeon look at them, free
Upload your prescription, OCT scans, angiograms or eye reports. Doç. Dr. Özer or Op. Dr. Bayram will tell you what they show and whether a further angiogram or treatment is likely to be needed, with no obligation.
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