This 76YO female presented with no visual symptoms, 20/40 vision, and an abnormal OCT in her left eye. What caused this subtle OCT finding?
She was previously being followed for asymptomatic focal vitreomacular traction (VMT) in this eye. On 12/12/22, Triton color imaging showed a subtle foveal cyst with focal VMT on swept-source OCT.
We recommended observation due to the absence of symptoms, and when she returned on 9/29/23, these findings spontaneously resolved as the vitreous separated, leaving a tiny outer foveal microdefect.
Learning Points:
Outer foveal microdefects (Cohen et al, Ophthalmology Retina 2021;5:553-561) have been described in numerous conditions, including macular telangiectasia, tamoxifen use, ABCA4 disorders (cone-rod dystrophies, Stargardt disease, and fundus flavimaculatus), phototoxicity, trauma, and vitreomacular traction disorders.
The prevalence of VMT increases with age, and is present in about 1% of people over 40YO. The natural history is still being defined, but most patients have stable traction and vision. VMT can also resolve spontaneously in about 20% (Errera et al, Ophthalmology 2018;125:701-707).
Many patients with VMT remain completely asymptomatic despite impressive OCT findings. We therefore almost always observe VMT, as in this case, unless the patient has significant symptoms.
