Case #44 – Dots, Spots, and Other White Retinal Lesions

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References E Zaharova, J Sherman. 2011. The use of SD-OCT in the differentia diagnosis of dots, spots and other white retinal lesions. Eye and Brain. 2011(3): 69-80. TC Chen, Cense, MC Pierce, et al. 2005. Spectral domain optical coherence tomography: ultra-high speed, ultra-high resolution ophthalmic imaging. Arch Ophthalmol. 123(12):1715-1720 S Alam, RJ Zawadzki, S

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Jerome Sherman, OD, FAAO Jerome Sherman, O.D., is perhaps optometry's most prolific writer, publishing over 650 clinical articles, research manuscripts, book chapters and two CDs. He is senior author of three books that were published in 2007, and has delivered over three thousand lectures both nationally and internationally. He has served as a

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Comments and Conclusions The cases above demonstrate the importance of SD-OCT in the identification of the unique reflective characteristics of the presented retinal abnormalities. The most common white dots and spots are exudates and drusen. Exudates, typically in the outer plexiform retina and drusen under the RPE, and are easily differentiated with SD- OCT.

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Case 15: Topcon 3D OCT Scan Images Note that the PIL is present in the right eye, but is missing in the left. This explains why direct patching of the right eye was unsuccessful at improving vision in the left eye, since the absence of the PIL indicates missing photoreceptors in the left eye.

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Case 15: Topcon 3D OCT Scan Images In the right eye (top image), the photoreceptor integrity line appears normal predicting normal best corrected visual acuity. The lower horizontal OCT section above the macula in the left eye reveals a hyperreflective RNFL which is so thick that the underlying structures are "shadowed" or "masked" by the

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Case 15: Topcon Fundus Images OD A 10-year-old male with BCVA 20/25 OD and 20/200 OS. Refractive error was +3.50-0.75x180 OD and -8.00 OS. The patient also had a left esotropia. The history revealed that direct patching of the right eye failed to improve the vision in the "amblyopic" left eye. The right eye appeared

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Case 14: Topcon 3D OCT Scan Images SD-OCT revealed an atrophic retina with no PIL and extremely thin RPE. The yellow crystals appeared as hyperreflective dots on the anterior surface of Bruch's membrane and more subtle deposits were scattered throughout the other retinal layers. The patient was diagnosed with Bietti's Crystaline Dystrophy, an autosomal recessive

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