Optical coherence tomography in adult-onset vitelliform dystrophy

Adult-onset vitelliform dystrophy (AOVD) is as a bilateral macular dystrophy that presents as a subretinal, oval, or round yellowish deposition in the macula. The lesions may be elevated and measure approximately 1/3 to 1 disc diameter (DD) in size. The dystrophy usually manifests between 30 and 50 years of age and has been genetically linked. Features of AOVD have been evaluated by optical coherence tomography (OCT). OCT examination shows subfoveal hyperreflective lesions lying on the retinal pigment epithelium (RPE) with slight separation between the RPE and photoreceptor layers. OCT is a diagnostic tool that provides insight into the morphologic characteristics of AOVD.

A 67-year-old black woman presented with complaints of decreased vision and metamorphopsia in her right eye of 1 year's duration. The patient's ocular history was positive for "macular degeneration" for which she was given eye vitamins. The patient's best-corrected visual acuities were 20/30 in the right eye and 20/20 in the left eye. Fundus examination found bilateral, subfoveal lesions. Optical coherence tomography demonstrated an elevated, well-circumscribed area of hyperreflectivity within the RPE in each eye. This description is that of a pattern-dystrophy of the RPE, namely, adult-onset vitelliform dystrophy.

OCT is a noninvasive instrument that provides information on the morphology of AOVD. It not only isolates the location of the lesion but can be utilized to monitor the stability of the condition. OCT interpretation of macular lesions can aid in diagnosis and management.