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Fundus autofluorescence (FAF) imaging is commonly used in ophthalmic clinics for diagnosis and monitoring of retinal diseases. Lipofuscin in the retinal pigment epithelium (RPE), with A2E as its most abundant component and a visual cycle by-product, is the major fluorophore of FAF. Lipofuscin accumulates with age and is implicated in degenerative retinal diseases. The amount of lipofuscin in RPE can be assessed by quantitative measurement of FAF. However, the currently available FAF imaging technologies are not capable of quantifying the absolute intensity of FAF, which is essential for comparing images from different individuals, and from the same individual over time. One major technical difficulty is to compensate the signal attenuation by ocular media anterior to the RPE (pre-RPE media). FAF intensity is also influenced by fluctuations in imaging conditions such as illumination power and detector sensitivity, all of which need to be compensated. In this review, we present the concept and research progress of using visible-light optical coherence tomography-based simultaneous multimodal retinal imaging to compensate signal attenuation by pre-RPE media and the influence of parameters of the acquisition system for accurate measurement of FAF intensities.    Impact statement   Quantitative fundus autofluorescence imaging with simultaneous visible-light optical coherence tomography-based multimodal technology has potential significant impact on the diagnosis and monitoring the progression of retinal diseases.

Visible-light optical coherence tomography-based multimodal system for quantitative fundus autofluorescence imaging