The clinical examination. Limitation and over-utilization of angiographic services

Fluorescein angiography has increased our understanding of the pathophysiology and appearance of most fundus disorders. Increased experience with the stereoscopic slit-lamp examination of the fundus has made it easier to predict what subsequent angiograms will demonstrate, and fluorescein studies are currently usually not required to make an appropriate diagnosis. Most cases of age-related macular degeneration and diabetic retinopathy can be managed without angiography, since most of the former are associated only with drusen and modest and progressive visual acuity loss and most cases of diabetic retinopathy are not associated with loss of visual acuity or with proliferative lesions. Angiography is an invaluable tool in evaluating newly symptomatic patients with the possibility of choroidal neovascularization, and it is also of great value in evaluating causes of visual acuity loss in diabetics as well as in the documentation of nonperfusion of their peripheral retinas.