Fundus imaging plays a vital role in research on the ophthalmology, diagnosis, and treatment of fundus diseases. Confocal scanning laser ophthalmoscope has superior imaging quality, wide applicability, and unique axial resolution, making it dominant in fundus imaging. We present a review of the principle and technical developments of confocal scanning laser ophthalmoscopy in ultra-wide field and high-resolution fundus imaging and analyze the challenges of confocal scanning laser ophthalmoscopy. Finally, we discuss the future development prospects based on existing challenges.