Fluorescein Angiography Interpretation Report

Patient: [name, MRN or DOB]

Date of Study: [date]

Laterality: [OD / OS / OU]

Study Type: [FA standard field / FA ultrawidefield]

Ordering Clinician: [name]

Interpreting Clinician: [name, credentials]

Images: [storage location and/or PACS/EHR accession ID]

Clinical Context

[Indication for FA] (State the clinical question in 1 sentence; if none provided, write "Indication not provided.") [Relevant ocular diagnoses and recent treatments influencing interpretation, such as anti-VEGF timing or prior laser] [Comparison to prior FA or relevant imaging with date and eye; if none available, state so briefly] (Keep to 2–3 sentences total.)

Technique & Quality

[Acquisition approach including field type, phases captured] [Contrast administration: fluorescein dose/route, any deviations] [Adverse reaction status] (State "No adverse reaction" if none; if reaction occurred, briefly describe and actions taken.)

Quality: [Good / Adequate / Limited / Non-diagnostic] (If Limited or Non-diagnostic, specify cause and note which assessments cannot be reliably made. Do not document absence of findings that cannot be assessed due to quality limitations.)

Findings

(Organize by eye. List only categories with relevant findings; omit categories without findings. Prioritize the most consequential findings first.)

OD

• Perfusion: [Capillary nonperfusion presence, location, and extent] (State unit: disc areas, % of imaged retina, or device index. Distinguish blocked fluorescence from true nonperfusion. Note collaterals or IRMA at ischemic borders if present.)
• Leakage: [Leakage / staining / pooling / window defect pattern and distribution with suspected source]
• Neovascularization: [NVD/NVE location, extent, and leakage intensity]
• Macula: [FAZ appearance, perifoveal capillary status, macular edema pattern if applicable]
• Other: [Choroidal filling abnormalities, RPE changes, or other pertinent findings]

OS

• Perfusion: [Capillary nonperfusion presence, location, and extent] (State unit: disc areas, % of imaged retina, or device index. Distinguish blocked fluorescence from true nonperfusion. Note collaterals or IRMA at ischemic borders if present.)
• Leakage: [Leakage / staining / pooling / window defect pattern and distribution with suspected source]
• Neovascularization: [NVD/NVE location, extent, and leakage intensity]
• Macula: [FAZ appearance, perifoveal capillary status, macular edema pattern if applicable]
• Other: [Choroidal filling abnormalities, RPE changes, or other pertinent findings]

Impression & Management Implications

1. [Diagnosis with laterality] — [Key supporting FA evidence] — [Clinical implication for management] (Use uncertainty qualifiers such as "suggestive of," "consistent with," or "cannot exclude" when warranted.)
2. [Additional diagnosis with laterality] — [Supporting evidence] — [Management implication]

(Include only as many items as clinically relevant and supported by findings.)

Critical/Unexpected Findings Communication: [finding communicated / recipient / method / date-time] (Include only if urgent findings required immediate communication; otherwise omit this line.)

Signature

[Interpreting clinician e-signature]

[Date/time of finalization]