Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.
On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.
A dilated fundus examination was performed demonstrating the following:
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Retina
Case 59
Contributor: Marko Tien (University of British Columbia Medical Student)
Patient Presentation: 68-year-old male was referred to ophthalmology for a macular assessment. He endorsed a 2-month history of metamorphopsia his right eye. VA was 20/30 OD and 20/25 OS. Fundus exam and OCT of the macula are shown below:
Question: Given the fundus photo and OCT in the right eye, what abnormality is seen?
Question: You examine another patient with AMD in clinic and obtain the following OCT scan. What are the hyper-reflective foci (yellow arrows)?
Question: What does the presence of hyper-reflective foci mean for the prognosis in this patient?
References:
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Ouyang, Y., Heussen, F. M., Hariri, A., Keane, P. A., & Sadda, S. R. (2013). Optical coherence tomography-based observation of the natural history of drusenoid lesion in eyes with dry age-related macular degeneration. Ophthalmology, 120(12), 2656–2665. https://doi.org/10.1016/j.ophtha.2013.05.029
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Schuman, S. G., Koreishi, A. F., Farsiu, S., Jung, S. H., Izatt, J. A., & Toth, C. A. (2009). Photoreceptor layer thinning over drusen in eyes with age-related macular degeneration imaged in vivo with spectral-domain optical coherence tomography. Ophthalmology, 116(3), 488–496.e2. https://doi.org/10.1016/j.ophtha.2008.10.006
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Roquet, W., Roudot-Thoraval, F., Coscas, G., & Soubrane, G. (2004). Clinical features of drusenoid pigment epithelial detachment in age related macular degeneration. The British journal of ophthalmology, 88(5), 638–642. https://doi.org/10.1136/bjo.2003.017632
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Balaratnasingam, C., Yannuzzi, L. A., Curcio, C. A., Morgan, W. H., Querques, G., Capuano, V., Souied, E., Jung, J., & Freund, K. B. (2016). Associations Between Retinal Pigment Epithelium and Drusen Volume Changes During the Lifecycle of Large Drusenoid Pigment Epithelial Detachments. Investigative ophthalmology & visual science, 57(13), 5479–5489. https://doi.org/10.1167/iovs.16-19816
Learning Objectives:
1. To identify intraretinal hyper-reflective foci on OCT
2. To understand the significance of intraretinal hyper-reflective foci for patients with AMD