This 19YO male has bilateral optic nerve coloboma with optic pit maculopathy in his left eye.
On initial presentation, vision was 20/70, which decreased to 20/200 at 3-month follow-up. The extent of the macular schisis/fluid dramatically enlarged, accounting for the drop in vision.
Optos fundus autofluorescence (FAF) showed variable hyper-FAF along the temporal edge of the fluid.
Triton OCT imaging showed an unusual inner retinal cyst, as well as subretinal fluid and outer macular schisis.
Remarkably, the patient felt his vision had improved subjectively and did not wish to consider the recommended vitrectomy procedure.
Learning Points:
While most optic pits are asymptomatic, they can cause vision loss by causing fluid to accumulate in the inner and outer retina and the subretinal space (optic pit maculopathy). The source of the fluid remains a point of ongoing debate, with potential contributions from the vitreous and/or subarachnoid space.
