FFA Indications

Fundus fluorescein angiography (FFA) has been the gold standard for retinal vascular imaging for decades — but its role has shifted meaningfully with the rise of OCT angiography (OCTA), which now serves as the first-line, non-invasive screening tool for many of the same conditions.

Classic indications for FFA

• Diabetic retinopathy: assessing macular ischemia, capillary non-perfusion, and neovascularization; guiding focal/grid laser and panretinal photocoagulation planning
• Retinal vascular occlusions: quantifying non-perfusion area and neovascular risk (central and branch retinal vein occlusion)
• Age-related macular degeneration: classifying choroidal neovascular membranes (classic vs. occult) and identifying leakage patterns
• Central serous chorioretinopathy: identifying the classic "smokestack" or "inkblot" leakage point
• Inflammatory and infectious retinal/choroidal disease: vasculitis, macular edema patterns, disc leakage
• Inherited retinal dystrophies and tumors: characterizing vascular patterns not otherwise visible

The current shift: where OCTA has taken over

For several of the indications above, OCTA now provides comparable or superior information non-invasively:

• OCTA detects microaneurysms and areas of non-perfusion in diabetic retinopathy with accuracy meeting or exceeding FFA in multiple comparative studies, without dye, venipuncture, or the (rare but real) risk of anaphylaxis
• OCTA provides depth-resolved visualization of individual capillary plexuses (superficial and deep), which FFA cannot distinguish
• OCTA can quantify foveal avascular zone size and vessel density objectively — FFA is qualitative by comparison

Where FFA still holds its ground

• Leakage assessment — OCTA shows structure and flow, but does not directly show vascular leakage/permeability the way dye-based FFA does; this remains a core FFA strength for CNV activity and CSCR leak-point localization
• Wide-field peripheral disease — conventional FFA with wide-field systems still offers established peripheral non-perfusion mapping, though ultra-widefield OCTA is closing this gap
• Situations needing dynamic, real-time transit — early/late phase timing differences are only available with dye-based angiography

Key references: Point-Counterpoint: Can OCTA Replace FFA in Diagnosing Posterior Segment Disorders? Clin Insights Eyecare. 2026.  |  Comparison of swept-source OCTA with FFA for detection of lesions in diabetic retinopathy. 2025.