Common retinopathies

Jade S Schiffman MD (Dr. Schiffman, Director of the Eye Wellness Center in Houston, Texas, has no relevant financial relationships to disclose.)
James W Walters PhD OD (Dr. Walters of the University of Houston has no relevant financial relationships to disclose.)
Rosa Ana Tang MD MPH MBA (Dr. Tang of the University Eye Institute at the University of Houston and Neuro-Ophthalmology of Texas, PLLC has no relevant financial relationships to disclose.)
David Alejandro Cardona MD (Dr. Cardona of Neuro-ophthalmology of Texas, PLLC, has no relevant financial relationships to disclose.)
James Goodwin MD, editor. (Dr. Goodwin of the University of Illinois at Chicago has no relevant financial relationships to disclose.)
Originally released May 5, 2006; last updated March 18, 2016; expires March 18, 2019

This article includes discussion of common retinopathies, age-related macular degeneration, Best disease, central areolar choroidal dystrophy, central serous chorioretinopathy, cone dystrophies, cystoid macular edema, familial drusen, juvenile retinoschisis, macular holes, multiple evanescent white-dot syndromes, rod-cone dystrophies or retinitis pigmentosa, serpiginous choroiditis, Stargardt disease, and white dot syndromes. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

The retinopathies and choroidopathies are a group of eye conditions that can cause central and peripheral visual loss, fundus changes, and electrophysiologic changes.

The etiology is variable (inherited, degenerative, inflammatory), and their recognition is important because of their confusion with optic neuropathies. In this update, the authors add information on congenital pigmented lesions of the retina, with emphasis on differentiating benign lesions from malignant ones. They also discuss optic disc edema associated with a macular star, the presence of which dramatically reduces the concern for demyelinating disease. The use of optical coherence tomography currently offers an objective gold standard for retinal nerve fiber layer analysis. The FDA-approved oral medication for multiple sclerosis, fingolimod, for which toxic macular edema has been reported as a side effect, warrants the need for baseline macular examination prior to beginning oral therapy.

Key points

 

• New retinal imaging modalities have emerged the most important for neurologists being optical coherence tomography, which allows visualization of the optic nerve and inner retinal layers, particularly in multiple sclerosis patients.

 

• Age-related macular degeneration is the leading cause of blindness in elderly persons in the United States. Micronutrient supplements are key to reducing the burden of age-related macular degeneration.

 

• Pharmacological therapy for wet age-related macular degeneration can be costly and create a major burden in the current healthcare system in the United States.

 

• Central serous retinopathy is a common mimicker of optic neuritis. It is worsened by steroids and is diagnosed by the use of optical coherence tomography. The condition usually resolves without treatment.

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