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This patient presented with 20/25 vision in her left eye with significant Amsler grid changes. There is an irregular RPE detachment (PED) with variably sized drusen, and OCT confirms a large PED. Fluorescein angiography shows a slightly uneven pattern of pooling beneath the PED. We discussed starting treatment due to her symptoms, but for now,… Read More

This patient has a retinal venous malformation (formerly known as retinal macrovessel), in addition to full panretinal photocoagulation (PRP) for proliferative diabetic retinopathy. Residual flat disc neovascularization remains despite full PRP. Learning Points: A retinal venous malformation is an anomalous retinal vessel that crosses the horizontal raphe (remember that normal retinal vessels respect the horizontal… Read More

This 71YO female presented with counting-finger vision in her right eye. Clinically, there are multiple layers of blood, including preretinal, intraretinal, and subretinal. These multiple layers are virtually pathognomonic for a ruptured retinal arterial macroaneurysm (RAM). Despite the causative RAM being just superotemporal to the optic nerve, significant intra- and subretinal fluid extends through the… Read More

Our patient presented with macular pigmentary changes, which were most pronounced in the right eye. Vision was counting fingers OD and normal OS. On further questioning, they gave a history of vision loss following West Nile encephalitis 6 months earlier. Although we can’t say for sure, these findings are most likely the sequelae of resolved… Read More

Our patient was referred for asymptomatic macular pigmentary changes. Vision was 20/20 OD and 20/25 OS. On further questioning, she reported severe vision loss with toxemia just before her now 16 YO daughter was born. Learning Points: Preeclampsia (toxemia of pregnancy), which usually develops in the third trimester, manifests as severe hypertension, swelling of the… Read More

This 20 YO male has a large area of myelinated nerve fiber layer (NFL) extending superiorly from the left optic nerve. This relatively uncommon and usually isolated finding is present at birth. Most patients are asymptomatic, although some may have a corresponding relative scotoma. Myelination can progress in about 10% of cases and can also… Read More

There is extensive chorioretinal scarring with optic atrophy in this patient who suffered severe blunt trauma 10 years earlier following a heroin overdose. Vision is now counting fingers (CF), but thankfully, the other eye is normal with 20/20 acuity. Note that the areas of intraretinal pigment migration mimic the bone spicules found with RP. Learning… Read More

This patient presented with bilateral idiopathic sclerochoroidal calcification, a relatively uncommon and benign finding in the elderly population. These yellowish choroidal lesions are slightly lumpy and elevated, and usually appear in the mid superior/inferior temporal/nasal quadrants. The lesions are highly reflective on B-scan ultrasonography and visible on CT. They require no treatment and are not… Read More

This patient presented with an acute submacular hemorrhage following a finger-to-eye injury. The subretinal blood slowly resolved over the following three months. An underlying choroidal rupture is almost always the source of this traumatic blood. Final vision was 20/400, either due to contusive foveal damage or possible toxicity from the subretinal blood. Learning Point: Choroidal… Read More

This patient had been followed for age-related macular degeneration (AMD) with bilateral confluent soft drusen. She then developed a large acquired vitelliform lesion overlying a retinal pigment epithelial detachment (PED) in her right eye. There are several PEDs also shown in the left eye. Learning Points: Vitelliform lesions are commonly found with other disorders, including… Read More