Some practical conclusions following a longitudinal study of common macular lesions

In a project which lasted 18 years, the natural history of five common macular lesions was followed in 268 patients, and the most significant clinical features selected in each. Methodology consisted of trichromatic analysis with direct ophthalmoscopy, contact lens fundoscopy including the triple mirror, refraction, and fundus photography. In several subjects in each group repeated fluorescence angiographies were carried out. Single eye records were kept and scattergrams of corrected visual acuities plotted. The latter--besides key clinical features--were then used to predict the probable course. Examples are related both to the biographies and to the clinical features to make the method more comprehensible. The five lesions studied were: cystoid macular degeneration, retinal pigment epithelial detachments, choroidal sclerosis, hyaline degenerations, and macular (foveal) degenerations. A new paramacular 'window' defect called a 'target' lesion is described and attention drawn to its close association with migraine. A feature of the study throughout was the frequency with which more than one of the lesions appeared in the same eye, although there was no set sequence. Thus a patient suffering from one macular lesion not infrequently ended by being blinded by another.