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JAMA Ophthalmology Clinical Challenge
December 2018

Atypical White Dot Syndrome in an Older Man

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Maryland Medical Center, Baltimore
  • 2Department of Ophthalmology and Visual Sciences, University of Chicago, Chicago, Illinois
JAMA Ophthalmol. 2018;136(12):1410-1411. doi:10.1001/jamaophthalmol.2018.2589

A white man in his mid-80s with an ocular history of remote left cataract extraction and a medical history of well-controlled hypertension, ankylosing spondylitis, ulcerative colitis, and osteoporosis was referred by an outside optometrist for possible birdshot chorioretinopathy. He denied any vision changes, eye pain, or light sensitivity. A comprehensive review of symptoms was negative, including no fatigue, weight loss, or night sweats. Best-corrected visual acuity was 20/40 OD and 20/30 OS. Anterior segment examination revealed ocular surface dryness and a nuclear sclerotic cataract in the right eye. On dilated fundoscopy, multiple yellow-white subretinal deposits were scattered throughout the left posterior pole, with parafoveal coalescence but sparing the far periphery. There was no concomitant vitritis (Figure, A). Optical coherence tomography showed choroidal thickening and irregularity of the overlying retinal pigment epithelium (Figure, B). The right eye was unremarkable.

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