This 79YO female was referred for asymptomatic retinal findings. She has a history of diet-controlled type 2 diabetes.
Optos color RG imaging shows scattered, round, deep retinal hemorrhages, some with white centers. Most of the midperipheral hemorrhages are much more extensive in her right eye.
Bloodwork, including CBC, serum viscosity, and serum protein electrophoresis, was normal. We suspect ocular ischemia as the cause of her findings, but despite numerous attempts, the patient continues to refuse carotid testing.
Learning Points:
The term “Roth spot” was named after Dr. Moritz Roth, who, in 1872, noted white-centered hemorrhages in patients with bacterial endocarditis. He felt that these white spots were septic emboli that originated from an infected cardiac valve. However, similar lesions can be seen in many other disorders, including leukemia, hyperviscosity, anemia, diabetes, and hypertension (Duane et al Ophthalmology 1980;87:66-69).
The white material may represent a variety of causes, including fibrin. So these lesions are best called white-centered hemorrhages, unless one is specifically referring to one of these lesions in a patient with bacterial endocarditis.
