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JAMA Ophthalmology Clinical Challenge
February 13, 2020

A Mysterious Central Scotoma in a Teenage Male Patient

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago
  • 2Division of Ophthalmology, NorthShore University HealthSystem, Evanston, Illinois
  • 3Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
JAMA Ophthalmol. Published online February 13, 2020. doi:10.1001/jamaophthalmol.2019.5383

A white teenage boy was referred for 3 months of bilateral reduced central visual acuity characterized as atraumatic, painless, constant, symmetric, and nonprogressive. His parents reported that he had recently been hospitalized for a suspected overdose with the medications atomoxetine, quetiapine, melatonin, fluoxetine, bupropion, and clonazepam, and shortly after, he reported central visual acuity loss. A dilated fundus examination with normal results had been documented 6 months prior to our examination.

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