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JAMA Ophthalmology Clinical Challenge
May 21, 2020

Visual Acuity Loss in a Healthy Man

Author Affiliations
  • 1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. Published online May 21, 2020. doi:10.1001/jamaophthalmol.2020.0452

A healthy man in his 60s presented with a 4-month history of blurred vision in his left eye. On examination, his visual acuity was 20/20 OD and 20/40 OS. Intraocular pressures were normal in each eye. Anterior segment and fundus examination results were normal in the right eye. In the left eye, the media were clear, and there were multiple patchy, yellow choroidal lesions with obliteration of the normal choroidal vasculature throughout the entire fundus (Figure 1A). There was no sign of vitritis or retinitis and no history of previous trauma, uveitis, sarcoidosis, or cancer. Ocular ultrasonography revealed diffuse ciliochoroidal thickening measuring 2.9 mm in elevation. Optical coherence tomography disclosed generalized, undulating choroidal infiltration in a seasick pattern, so to speak, given its resemblance to a stormy ocean surface, with overlying draping of the retina in the foveal region (Figure 1B).

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