Common retinopathies

Jade S Schiffman MD (Dr. Schiffman, Director of the Eye Wellness Center in Houston, Texas, has no relevant financial relationships to disclose.)
Francisco R Sanchez Moreno MD (

Dr. Sanchez Moreno of Mayo Clinic School of Graduate Medical Education 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 Neuro-ophthalmology of Texas, PLLC, has no relevant financial relationships to disclose.

)
Heather E Moss MD PhD, editor. (

Dr. Moss of Stanford University has no relevant financial relationships to disclose.

)
Originally released May 5, 2006; last updated July 25, 2020; expires July 25, 2023

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

 

• Retinal imaging modalities such as optical coherence tomography can help the neurologist to identify retinal disorders and distinguish them from optic nerve disorders.

 

• Optical coherence tomography imaging of the receptor layer can help identify juvenile and age-related macular degeneration and help differentiate these from inherited rod and cone dystrophies.

 

• Electrophysiological testing can be helpful to differentiate functional disorders of the retina and optic nerve.

 

• Age-related macular degeneration is the leading cause of blindness in elderly persons in the United States. The wet (neovascular form) accounts for most of the serious loss of central vision. Optical coherence tomography angiography can identify neovascular anomalies and areas of ischemia without injecting fluorescein, making earlier detection and treatment possible.

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