Bleeding inside the eye
Limitations Media opacity and hemorrhage can block fluorescence; a prior severe fluorescein reaction requires specific risk assessment.
About the service
Fluorescein angiography examines fundus vessels after intravenous fluorescein injection. Sequential images assess circulation and dye leakage, which OCT angiography does not directly show.
Who the service is for
What matters for the examination
FFA relies on fluorescence of sodium fluorescein after intravenous administration. Sequential imaging captures vascular filling over time, allowing assessment of filling delay, blocked fluorescence, staining and extravascular spread of dye. The ability to visualize dynamic leakage makes FFA particularly useful in diabetic retinopathy, retinal vascular occlusion, neovascular disease and inflammatory conditions.
Diagnostic protocol
Renal disease should not automatically be treated as an absolute contraindication by analogy with iodinated CT contrast; the clinician assesses the individual patient and local protocol.
Reactions to fluorescein
Nausea, transient weakness, itching or urticaria are recognized adverse reactions; anaphylaxis is uncommon but potentially life-threatening. Temporary yellow discoloration of skin and bright yellow/orange urine can occur as fluorescein is eliminated. A previous reaction to fluorescein itself is more clinically relevant.
Allergies and tolerance
Shellfish, “iodine” or iodinated radiographic-contrast allergy does not automatically imply cross-allergy to fluorescein.
Role of the method
FFA does not replace structural OCT or OCT angiography. These modalities answer different questions and are often complementary.
Angiography without X-rays
FFA is not an X-ray examination: the image series is obtained with an ophthalmic camera or scanning laser ophthalmoscope rather than an X-ray machine.
Control of intraocular inflammation
Diseases / risk groups Diabetic retinopathy, retinal vein occlusion, neovascular AMD, central serous chorioretinopathy, uveitis/vasculitis and selected other retinal disease. Preparation History review, pupil dilation, IV access and serial imaging; KazRIED-specific requirements must be confirmed.
Pupil dilation
The pupil is usually dilated for imaging.
Travel after the appointment
Blurred near vision and increased light sensitivity may last for several hours after dilation, so do not plan to drive yourself immediately after the examination.
Monitoring over time
Bring previous OCT and OCT angiography results, fundus photographs, medical summaries and a medication list, especially for follow-up examinations.
Pregnancy and breastfeeding
Tell the doctor in advance about a previous reaction specifically to fluorescein, bronchospasm or asthma, severe allergic reactions, pregnancy, breastfeeding and chronic diseases. If you are breastfeeding, discuss the plan in advance.
Early detection of changes
Do not stop regular antihypertensive, glucose-lowering or other long-term medication on your own. Discuss all medicines with the clinical team.
Food and drink before testing
A special diet is usually unnecessary. KazRIED-specific fasting or fluid instructions should be confirmed because local protocols may differ.
Individual treatment choice
Current references do not provide one universal interruption interval after IV fluorescein; the decision depends on the clinical situation and local policy.
Symptoms requiring urgent care
Who may need it? Patients in whom a retinal specialist needs to assess perfusion, vascular permeability or activity of abnormal vessels. Symptoms / complaints Reduced vision, a spot or haze, distorted lines or sudden changes in a known retinal disease are reasons for examination; the doctor determines whether FFA is needed.
When urgent care is needed
Urgent assessment Sudden loss of vision, a new curtain-like shadow, significant pain, neurological symptoms or an acute vascular event require urgent in-person assessment rather than booking only FFA yourself. Rare severe systemic reactions can occur, so the test should be performed where staff can provide emergency treatment.
Assessment before choosing treatment
FFA is an invasive diagnostic test because dye is injected intravenously.
Limitations and safety
FFA is an invasive diagnostic test because dye is injected intravenously. Rare severe systemic reactions can occur, so the test should be performed where staff can provide emergency treatment.
Book a consultation
Stages
Stage 1
Confirm indication and safety
The clinician reviews diagnosis, previous angiography, fluorescein reactions, allergy history, systemic disease, pregnancy and breastfeeding.
Takes: 5 min
Stage 2
Preparation for imaging
In Almaty the test is performed fasting, with an ophthalmologist's assessment required beforehand.
Takes: 40 min
Stage 3
Inject fluorescein
The dye is injected intravenously according to the local protocol.
Takes: 1 min
Stage 4
Early image sequence
The imaging system records the first seconds and early vascular-filling phases.
Takes: 15 s
Stage 5
Later-phase images
Late leakage, staining, pooling and blocked fluorescence are assessed; delayed images may be added when indicated.
Takes: 45 s
Stage 6
Observation and interpretation
The patient is observed for 30 minutes after dye injection; the doctor assesses images and provides the result.
Takes: 30 minutes of observation
Service benefits
Detecting vascular leakage
Fluorescein angiography shows dye leaking from abnormal vessels and helps assess vascular permeability.
Blood flow over time
A sequence of angiography images shows dye passing through vessels at different stages.
Finding areas of reduced blood supply
Angiography helps locate poorly perfused retinal areas and assess the extent of vascular changes.
Information to guide treatment
Angiography findings help clarify the need for laser treatment, other interventions and follow-up.
FFA and angiographic/optical modalities
Criterion
FFA
OCT angiography
Structural OCT
Fundus photo
ICG angiography
Principle
IV fluorescein + sequential fluorescence imaging
Red-blood-cell movement detected through repeated OCT scans
Optical reflectivity of tissue layers
Reflected-light fundus photography
IV indocyanine green + near-infrared imaging
Injected dye
Yes
No
No
No
Yes
Dye leakage
Yes; major strength
No direct leakage
No
No
Yes, but different dye/clinical role
True time phases
Yes: arterial, venous and late phases
No dye-transit phases
No
No
Yes
Depth-resolved vascular map
Limited; 2D projection
Yes
No vascular map
No
Limited
Capillary non-perfusion
Strong when image quality is adequate
Strong but flow-threshold/artifact dependent
Indirect
Indirect
Not the primary retinal capillary-map test
Microaneurysms
Strong
Some may be missed
Indirect
Some are visible as dots or haemorrhages, but not through leakage
Not primary
Neovascularization
Yes, including leakage activity
Network morphology without leakage
Indirect via fluid/structure
Sometimes morphologically visible
Strong for choroidal vasculature
Choroid
Limited by pigment and choriocapillaris fluorescence
Depth-resolved but artifact/device dependent
Structural choroid
Limited
Major strength
Media opacity
Image quality decreases
Image quality decreases
Image quality decreases
Image quality decreases
Near-IR may penetrate some opacity/blood better, not universally
Systemic risk
IV-dye reaction risk
No dye risk
No dye risk
No dye risk
IV-dye reaction risk
FFA
Principle
Injected dye
Dye leakage
True time phases
Depth-resolved vascular map
Capillary non-perfusion
Microaneurysms
Neovascularization
Choroid
Media opacity
Systemic risk
IV fluorescein + sequential fluorescence imaging
Yes
Yes; major strength
Yes: arterial, venous and late phases
Limited; 2D projection
Strong when image quality is adequate
Strong
Yes, including leakage activity
Limited by pigment and choriocapillaris fluorescence
Image quality decreases
IV-dye reaction risk
Red-blood-cell movement detected through repeated OCT scans
No
No direct leakage
No dye-transit phases
Yes
Strong but flow-threshold/artifact dependent
Some may be missed
Network morphology without leakage
Depth-resolved but artifact/device dependent
Image quality decreases
No dye risk
Optical reflectivity of tissue layers
No
No
No
No vascular map
Indirect
Indirect
Indirect via fluid/structure
Structural choroid
Image quality decreases
No dye risk
Reflected-light fundus photography
No
No
No
No
Indirect
Some are visible as dots or haemorrhages, but not through leakage
Sometimes morphologically visible
Limited
Image quality decreases
No dye risk
IV indocyanine green + near-infrared imaging
Yes
Yes, but different dye/clinical role
Yes
Limited
Not the primary retinal capillary-map test
Not primary
Strong for choroidal vasculature
Major strength
Near-IR may penetrate some opacity/blood better, not universally
IV-dye reaction risk
Clinical tasks: complementary roles
Clinical task
FFA
OCTA
Structural OCT
Fundus photo
Diabetic retinopathy
Non-perfusion, microaneurysms, leakage, neovascularization
Vascular map/neovascularization without leakage
Macular edema and structure
Fundus documentation
Diabetic macular edema
Shows leakage distribution
No direct leakage
Best for fluid/thickness quantification
Limited
Neovascular AMD
Active leakage and angiographic patterns
Vascular network morphology
Fluid, PED and structure
Background documentation
Retinal vein occlusion
Non-perfusion, leakage, neovascularization
Vascular network without leakage
Macular edema
Hemorrhage and overall fundus appearance
Central serous chorioretinopathy
Leakage points/patterns
Choriocapillary flow changes, no leakage
Subretinal fluid/PED
Documentation
Uveitis / vasculitis
Vascular leakage and wall staining
Flow deficits, but not active leakage
Macular edema/structure
Visible inflammatory lesions
Optic disc
Disc leakage/staining
Peripapillary vasculature
RNFL/GCC and disc structure
Photo documentation
Hemorrhage blocks view
Fluorescence may be blocked
Flow signal may be unavailable
OCT signal may be attenuated
Image is obscured
Frequent repeat testing
Limited by invasiveness/reaction risk
Easy to repeat
Easy to repeat
Easy to repeat
Pregnancy
Usually avoided unless strongly indicated
No injected dye; often preferable if it answers the question
No injected dye
No injected dye
Treatment planning
Strong for leakage/ischemia mapping
Strong for vascular morphology
Strong for fluid/anatomy
Strong for documentation
FFA
Diabetic retinopathy
Diabetic macular edema
Neovascular AMD
Retinal vein occlusion
Central serous chorioretinopathy
Uveitis / vasculitis
Optic disc
Hemorrhage blocks view
Frequent repeat testing
Pregnancy
Treatment planning
Non-perfusion, microaneurysms, leakage, neovascularization
Shows leakage distribution
Active leakage and angiographic patterns
Non-perfusion, leakage, neovascularization
Leakage points/patterns
Vascular leakage and wall staining
Disc leakage/staining
Fluorescence may be blocked
Limited by invasiveness/reaction risk
Usually avoided unless strongly indicated
Strong for leakage/ischemia mapping
Vascular map/neovascularization without leakage
No direct leakage
Vascular network morphology
Vascular network without leakage
Choriocapillary flow changes, no leakage
Flow deficits, but not active leakage
Peripapillary vasculature
Flow signal may be unavailable
Easy to repeat
No injected dye; often preferable if it answers the question
Strong for vascular morphology
Macular edema and structure
Best for fluid/thickness quantification
Fluid, PED and structure
Macular edema
Subretinal fluid/PED
Macular edema/structure
RNFL/GCC and disc structure
OCT signal may be attenuated
Easy to repeat
No injected dye
Strong for fluid/anatomy
Fundus documentation
Limited
Background documentation
Hemorrhage and overall fundus appearance
Documentation
Visible inflammatory lesions
Photo documentation
Image is obscured
Easy to repeat
No injected dye
Strong for documentation
Book an appointment
FFA is best scheduled after ophthalmologist/retinal-specialist assessment or with a referral so that the indication and IV-dye risk can be reviewed in advance.
Procedure prices
Service name
Price
Fundus fluorescein angiography
from 68 500 ₸
per eye
Our doctors
A team of experienced doctors across specialties.
Experience: 23 years
Ophthalmologist, OCT Diagnostics
Asylbekova Asel Serikovna
Candidate of Medical Sciences; Highest-category ophthalmologist
Experience: 17 years
Ophthalmologist, Ultrasound and OCT Diagnostics
Zhanysbaeva Akmaral Esmyrzaevna
Highest-category ophthalmologist
Experience: 18 years
Ophthalmologist, Ultrasound and OCT Diagnostics
Musaeva Zarina Maksimovna
Highest-category ophthalmologist
Experience: 8 years
Ophthalmologist, Ultrasound and OCT Diagnostics
Amanzhanova Aziza Asqarqyzy
Experience: 10 years
Ophthalmologist, Ultrasound and OCT Diagnostics
Kulamanova Bayan Adilbekovna
Fluorescein Angiography (FA)
FA is based on the fluorescence of sodium fluorescein following intravenous injection. The imaging system captures a series of images at different time points.
What does FA show?
The clinician assesses not only the shape of the vessels but also their filling sequence, blockage of fluorescence, tissue staining, and leakage of dye beyond the blood vessels.
When is the examination used?
The ability to observe dye leakage over time makes FA particularly useful in diabetic retinopathy, vascular occlusions, neovascular processes, and inflammation.
How are the results assessed?
At KazNII, FA findings should be interpreted alongside a fundus examination, optical coherence tomography (OCT), and, when necessary, OCT angiography.
Inject fluorescein
The dye is injected intravenously according to the local protocol. Staff monitor how the patient feels.
Why is fluorescein angiography still needed when OCT angiography is available?
OCT angiography (OCTA) is useful for noninvasive, layer-by-layer mapping of the vascular network and frequent follow-up examinations.
However, it detects signals from blood flow and does not show dye leaking through an abnormally permeable vessel wall.
Fluorescein angiography (FA) captures vascular changes over time and directly demonstrates dye leakage, tissue staining, and areas of vascular nonperfusion.
For some retinal diseases, choosing between FA and OCTA therefore goes beyond comparing an “old” method with a “new” one. The clinician selects the examination according to the clinical question and may sometimes request both.
Facts and offers
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Related services
Frequently asked questions
What is fundus fluorescein angiography?
Fundus fluorescein angiography is a sequence of fundus images taken after intravenous fluorescein injection. It allows assessment of vascular filling, perfusion abnormalities, abnormal fluorescence and dye leakage.
How is FFA different from OCT angiography?
FFA requires intravenous dye and shows dynamic dye transit and leakage. OCT angiography does not require intravenous dye and provides depth-resolved vascular maps, but it does not directly demonstrate leakage.
Why is fluorescein injected?
Fluorescein circulates in the bloodstream and fluoresces under specific excitation light, allowing the imaging system to record vascular filling and abnormal permeability.
What does “leakage” mean on FFA?
Leakage is the progressive spread of fluorescence beyond a vessel on later images. It may indicate abnormal vascular permeability, neovascularization or inflammation.
What is a non-perfusion area?
It is an area where capillaries show reduced or absent dye filling. Its significance depends on the extent, location and underlying disease.
Which conditions may require FFA?
FFA may be used in diabetic retinopathy, retinal vascular occlusions, neovascular age-related macular degeneration, central serous chorioretinopathy, inflammatory eye disease and selected intraocular tumours.
Why is FFA used in diabetic retinopathy?
It can show microaneurysms, capillary non-perfusion, ischemia, neovascularization and vascular leakage, helping guide monitoring and treatment decisions.
Why is FFA used in age-related macular degeneration?
FFA helps assess abnormal vessels and leakage when macular neovascularization is suspected. Findings are usually interpreted together with OCT and, when needed, OCT angiography.
Why is FFA used in retinal vein occlusion?
It helps assess areas of non-perfusion, vascular leakage, macular involvement and signs of neovascularization.
Is FFA used in central serous chorioretinopathy?
Yes, when clinically indicated. FFA can demonstrate characteristic leakage points and patterns, while OCT is commonly used to assess fluid and retinal structure.