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This 30YO male presented with acute unilateral vision loss of 20/50 in his right eye. Ocular examinations were normal bilaterally except for a small area of retinal edema with a subretinal pigment ring in the right inferotemporal fovea. Swept-source OCT shows a hyperreflective macular neovascularization (MNV) mostly above the RPE. Elevated RPE partially extends into… Read More

This 64YO male presented with 20/25 vision and asymptomatic vitreomacular adhesion (VMA) in his right eye. Over the next 8 months, this progressed to subtle focal vitreomacular traction (VMT) and eventually a small full-thickness macular hole without traction. Vitrectomy surgery was recommended. Learning Points: In 1988, Dr. Gass described his concept for the pathogenesis of… Read More

This healthy 13YO boy presented with these asymptomatic findings in his right eye. Vision was 20/20 OU. Optos imaging shows classic findings for Coats disease in the temporal periphery, including telangiectatic vessels, a macroaneurysm, scattered mild lipid, and ischemic retina more distally. Fluorescein angiography more dramatically illustrates these vascular changes. The macroaneurysm stains. Learning Points:… Read More

This 68YO female presented with these asymptomatic multifocal subretinal yellow posterior pole lesions. Vision is 20/20 OU. The sharply demarcated yellowish lesions are markedly hyper-autofluorescent and are hyperreflective on Triton swept-source OCT. There was no known family history, but genetic testing revealed a heterozygous pathogenic BEST1 mutation. Learning Points: Best disease is associated with a… Read More

This 65YO female presented with 20/400 vision in her right eye. An acute inferior subhyaloid hemorrhage was noted along with non-central diabetic macular edema. Over the coming months, macular laser followed by panretinal photocoagulation (PRP) was performed. One year later, vision was 20/50, with complete resolution of the preretinal blood and proliferative disease. Learning Points:… Read More

This 75YO female has a history of bilateral uveal malignant melanoma and is now monocular following enucleation of her left eye in 2001. Plaque therapy in 2011 successfully saved her right eye, and the tumor has completely regressed. Unfortunately, vision is 20/200 due to prior radiation retinopathy and possible glaucomatous optic neuropathy. Learning Points: In… Read More

This patient presented with a macula-on rhegmatogenous retinal detachment (RRD) from a large nasal retinal tear. The tear has a rolled posterior edge, indicating possible early proliferative vitreoretinopathy. The hydration outer retinal folds at the posterior edge of the detachment are one of the key clinical findings that help differentiate a rhegmatogenous from exudative and… Read More

This 61YO male presented with classic findings for idiopathic central serous chorioretinopathy (ICSC). There is a large serous macular detachment that is diffusely hyperautofluorescent. Fluorescein angiography shows a small dot of early hyperfluorescence with a late smokestack leak. Triton swept-source OCT shows the serous detachment with a small underlying RPE detachment near the area of… Read More

This is a patient with retinitis pigmentosa, but do you see Jack O’Lantern or Jack Skellington? Maybe something else spooky?

This patient presented with an asymptomatic yellowish, nodular subretinal lesion inferonasal to the right optic nerve. Spectral domain optical coherence tomography shows that the lesion originates from the sclera.  Learning Points: Focal scleral nodule (previously known as solitary idiopathic choroiditis [SIC] and unifocal helioid choroiditis) presents as a single, yellow-white, elevated nodular, avascular subretinal lesion…. Read More