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JAMA Ophthalmology Clinical Challenge
July 8, 2021

Split Down the Middle of the Fovea

Author Affiliations
  • 1Edward S. Harkness Eye Institute, NewYork–Presbyterian Hospital, Columbia University Irving Medical Center, New York
  • 2Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Ophthalmol. Published online July 8, 2021. doi:10.1001/jamaophthalmol.2020.6869

A woman in her 50s with hypertension who was otherwise in good health presented for new ophthalmologic evaluation in the setting of mild, long-standing blurred vision with slight metamorphopsia in the right eye. She had a history of high myopia (approximately 9 diopters [D] OD; 8 D OS). Examination revealed an otherwise normal left eye with 20/20 best-corrected visual acuity (BCVA). The right eye demonstrated a BCVA of 20/25 and normal anterior segment, including lenticular examination. Dilated fundus examination showed wrinkling of the neurosensory retina at the fovea (Figure 1A) without posterior vitreous detachment. Spectral-domain optical coherence tomography revealed hyperreflective layering on the foveal surface consistent with epiretinal membrane, as well as splitting of the outer plexiform layer with hyporeflective cavities (Figure 1B).

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