High-altitude retinopathy with isolated ellipsoid zone loss: a case report
Johnathan Abraham Bailey1, Maximilian Daechul Kong1,2, Baichun Hou1
1Department of Ophthalmology, Vanderbilt Clinic, Columbia University Irving Medical Center, 622 W 168Th St 3Rd Floor, New York, NY, 10032, USA.
Documenta Ophthalmologica. Advances in Ophthalmology
|January 6, 2026
Summary
High-altitude retinopathy (HAR) can cause isolated central photoreceptor damage, even without vascular issues. This case suggests high-altitude retinal injury may involve non-vascular, metabolic, or hypoxic insults, especially in those with prior retinal conditions.
Area of Science:
- Ophthalmology
- Altitude Medicine
- Retinal Imaging
Background:
- High-altitude retinopathy (HAR) is a condition affecting vision at high altitudes.
- Previous understanding of HAR primarily focused on vascular changes.
Purpose of the Study:
- To document a unique case of High-altitude retinopathy (HAR).
- To detail the multimodal imaging and functional assessments used to evaluate the condition.
Main Methods:
- A comprehensive multimodal imaging protocol was employed, including color fundus photography, fundus autofluorescence (FAF), and spectral-domain optical coherence tomography (OCT).
- Functional assessment was performed using standard full-field electroretinography (ERG) to measure photoreceptor activity.
Main Results:
- A patient presented with acute vision loss after high-altitude exposure, showing foveal EZ loss on OCT without vascular compromise.
- OCT angiography confirmed intact retinal and choroidal perfusion, ruling out ischemic injury.
- Treatment with N-acetylcysteine led to visual improvement and partial EZ recovery.
Conclusions:
- This case reveals a novel HAR manifestation: isolated central photoreceptor damage (EZ line loss) without vascular involvement.
- Findings suggest hypoxia-induced injury due to high metabolic demand in foveal cones, particularly in individuals with pre-existing retinal degeneration.
- Ophthalmologists should consider non-vascular mechanisms in high-altitude retinal injuries, especially in patients with underlying retinal diseases.
