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This 41YO male presented after a recent hospitalization for severe hypertension with vision of counting fingers OD and 20/60 OS. The bilateral nerve fiber layer infarcts (cotton-wool spots) are more characteristic of hypertension than of diabetes. Severe retinal hemorrhages and disc neovascularization are noted in each eye. The right eye, in particular, is severely ischemic,… Read More

The fiery dragon decided to make an appearance in the back of this patient’s eye. This dangerous predator caused its human prey to experience large black floaters and flashing lights. Fortunately, the beast, aka retinal tear, was vanquished with an in-office barrier laser.

This 66YO female presented with acute vision loss of her right eye. There was no family history of eye disease. Extensive variably sized drusen were noted in both maculae, with subretinal blood from macular neovascularization (MNV) in her right eye. OCT scanning shows variably sized and peaked drusen and subretinal hyperreflective material (SHRM) reminiscent of… Read More

This patient has choroideremia and, luckily, has preserved central 20/30 vision bilaterally. Fundus photography shows patchy areas of RPE and chorioretinal atrophy. Learning Points: Choroideremia is an X-linked recessive chorioretinal dystrophy caused by a mutation in the CHM gene. Some female carriers can still develop choroideremia due to irregular inactivation of the X chromosome (lyonization)…. Read More

This 42YO female presented with counting fingers vision OD and 20-25 vision OS. There was no family history of vision loss. A bull’s-eye pattern of perifoveal atrophy was noted on Optos color and fundus autofluorescence imaging, with loss of photoreceptors on OCT. The outer retinal atrophy extended through the macular center in her right eye,… Read More

This 76YO male presented with normal vision and asymptomatic bilateral retinal hemorrhages following a recent diagnosis of multiple myeloma. There are a variety of retinal hemorrhages seen on Optos and green-channel images, including inner retinal white-centered hemorrhages and deep blot hemorrhages in the outer plexiform layer. Learning Points: White-centered hemorrhages or “roth spots” can be… Read More

This patient presented with a symptomatic macula-on giant-tear retinal detachment (RD) in his left eye. The giant tear extends from about 12 to 4 o’clock with an additional tear noted superonasally. One day after vitrectomy with Perfluoron (PFO, perfluoro octane) injection, the retina is completely attached, with fresh white encircling laser scarring. Some PFO bubbles… Read More

Our patient shows classic bilateral findings of macular telangiectasia type 2 (MacTel2) with temporal foveal intraretinal pigment migration and inner retinal crystals, as well as angiographic staining and leakage. Our patient’s optical coherence tomography scans also show classic findings of mostly temporal foveal retinal atrophy, disorganization, and hyporeflective tissue loss (cavitations). Learning Points: MacTel type… Read More

Retinal cavernous hemangiomas are usually unilateral, inner retinal grape-like clusters of aneurysms filled with dark venous blood. A gray fibrotic membrane often covers its superficial surface. Vision is usually normal, and no treatment is required. Rarely, vision loss can occur from vitreous hemorrhage. Learning Points: Although most occur sporadically, some may be associated with an… Read More

We have been caring for this patient and his family with Von Hippel-Lindau (VHL) disease for over 20 years. We initially treated the retinal capillary hemangioma in his left eye with cryotherapy. Although the tumor initially regressed, thermal laser photocoagulation was applied due to some new exudation. The exudation eventually resolved. A few smaller involuted… Read More