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This 66yo male is CF OD and 20/200 OS. He has a history of retinal detachment surgery OD, as well as severe glaucoma. His right eye has a possible morning glory anomaly (no central vessels with possible overlying glial tissue, radiating numerous retinal vessels) versus severe glaucomatous damage. The intraretinal pigment migration nasally is from… Read More

This patient presented with vision loss from an acute submacular hemorrhage following blunt trauma. Subsequent images, 3 weeks later and 2 months later, show gradual resolution of the blood with the appearance of an underlying choroidal rupture. Learning Point: Choroidal ruptures are caused by blunt ocular trauma and are always circumferential with respect to the… Read More

This patient has PDR and prominent neovascularization of the disc (NVD), which is well-captured by the OCT angiogram. Movement artifacts are noted throughout the scan. The bottom-right image isolates the vitreoretinal interface, showing only the NVD. Learning Points: The OCT angiogram captures blood vessels from the full-thickness retina, including the superficial radial peripapillary capillary network,… Read More

This 72yo female was on pentosan polysulfate sodium (PPS, Elmiron) for 5-10 years in the 1990s and was previously misdiagnosed with dry age-related macular degeneration (AMD). While her fundus exam may resemble pigmentary changes associated with dry AMD, there are no drusen. Fundus autofluorescence (FAF) shows a mixture of hyper- and hypo-autofluorescent spots in the… Read More

This patient has a broad encircling scleral buckle that’s beautifully imaged in this Optos photograph. Learning Points: The normal neurosensory retina remains attached to the RPE due to numerous physiologic mechanisms, including the inner (retinal vascular endothelium) and outer (tight junctions at the apex of the RPE cells) blood retinal barriers, hyperosmotic choroid passively drawing… Read More

Our patient has 20/20 vision OD and 20/400 OS. He has classic peripapillary atrophy, macular and peripheral scarring. He came in with symptomatic vision loss in his left eye with a subtle nasal foveal subretinal hemorrhage from an acute macular neovascularization (MNV) adjacent to a pre-existing chorioretinal scar. The OCT line scan surprisingly shows significant… Read More

Our patient shows classic findings for adult-onset foveomacular vitelliform dystrophy (Adult Best’s) including small, round, symmetrical subfoveal yellow spots, which is seen on OCT as subretinal hyperreflective material between the RPE and outer retina. Additionally, the vitelliform lesions provide a great example of shadowing of the underlying choroid. Shadowing occurs when a hyperreflective structure prevents… Read More

This patient has classic findings for acute placoid syphilis in the right eye. The fundus photo demonstrates an orange-yellow subretinal lesion. OCT shows attenuation of the outer retinal layers (including the ellipsoid zone) and a thickening of the RPE. Angiographically, this inflammatory lesion blocks early and stains late. The patient was referred to the infectious… Read More

This 14YO female presented with difficulty distinguishing colors and seeing the yellow softball when batting. Vision was 20/30 OD and 20/25 OS. Her fundus examinations were normal. However, OCT scanning shows a pathognomonic loss of the photoreceptor layers outer to the external limiting membrane. Fundus autofluorescence shows foveal hypofluorescence corresponding to the angiographic bull’s-eye lesions…. Read More

The fundus photo shows an unusual peripapillary pigmented epiretinal membrane distorting the underlying retina. The OCT shows a partially detached epiretinal membrane and marked hyperreflectivity of the inner retina, with loss of normal retinal layer detail. Fluorescein angiography shows a distorted retinal vasculature with late leakage. Occasionally, vitrectomy with membrane peeling can be offered, but… Read More