This 51YO female was referred for asymptomatic retinal hemorrhages in each eye. She had a history of pulmonary hypertension. Vision was 20/20 bilaterally.
Optos color RG imaging shows scattered retinal hemorrhages in all quadrants, most of which are deep with white centers. A complete blood count revealed a hemoglobin of 18.0 g/dl, and she was immediately referred for a hematology consult.
Subsequent hematologic workup was negative, and she was felt to have secondary polycythemia from her pulmonary hypertension. She has since been treated with serial phlebotomies.
When last examined 5 months later, the retinal hemorrhages were markedly decreased, and her hemoglobin had decreased to 14.4 g/dl.
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 those found associated with bacterial endocarditis.
