Search results (885 results)

Apr 21 2025 by Virginia Gebhart

28 year old male with stable retinitis pigmentosa and optic disc drusen OU. Bardet-Biedl variant identified in previous genetic testing. BCVA 20/50 OD, 20/30 OS

Photographer: Virginia Gebhart, Retina Consultants of Carolina

Imaging device: Optos California

Condition/keywords: Drusen, optic disc drusen, retinitis pigmentosa

Apr 21 2025 by rohan jain

Retro image of a 44 year-old woman with Familial Dominant Drusen.

Photographer: Dr. ROHAN JAIN

Condition/keywords: drusen, FAMILIAL DOMINANT DRUSEN, retro mode

Apr 18 2025 by DR Rohit Gupta

The **myelinated nerve fibers of the optic disc** (also known as **medullated nerve fibers**) are retinal nerve fibers that retain their myelin sheath as they pass through the optic nerve head. Normally, retinal nerve fibers are unmyelinated to allow for light transparency, but in some cases, myelination extends anteriorly into the retina, appearing as a striking white, feathery patch on the optic disc or peripapillary retina. ### **Key Features:** 1. **Appearance:** - Dense, white, striated patches with feathery edges. - Typically located at the superior or inferior pole of the optic disc. - May obscure retinal vessels underneath. 2. **Clinical Significance:** - Usually **benign** and asymptomatic. - **Congenital** (present at birth or early childhood). - Rarely associated with **visual field defects** (e.g., scotomas corresponding to the area of myelination). - Occasionally linked with **high myopia** or **amblyopia** if extensive. 3. **Pathophysiology:** - Failure of oligodendrocytes or Schwann cells to stop myelination at the lamina cribrosa. - Normally, myelination stops at the optic nerve head, but in this condition, it extends into the retina. 4. **Diagnosis:** - **Fundoscopy:** Classic white, feathery appearance. - **Optical Coherence Tomography (OCT):** Shows thickened retinal nerve fiber layer (RNFL). - **Visual Field Testing:** May detect defects if large. 5. **Differential Diagnosis:** - Optic disc edema - Cotton wool spots - Retinoblastoma (rarely, but must be ruled out in children) 6. **Management:** - No treatment required if asymptomatic. - Monitor for amblyopia in children. - Rare cases with significant visual impairment may need further evaluation. ### **Fun Fact:** Myelinated nerve fibers are seen in **~0.5-1%** of the population and are usually an incidental finding.

Photographer: Dr Rohit gupta

Imaging device: Samsung S21

Condition/keywords: Medulated Nerve fibre, Medullated Nerve fibres, myelinated nerve fibers, Myelinated Nerve Fibres, optic disc drusen

Mar 13 2025 by T. P . VIGNESH, MBBS,MS

Fundus photograph of an 42-year-old man with familial dominant drusen.

Photographer: Sivanath

Imaging device: EIDON

Condition/keywords: FAMILIAL DOMINANT DRUSEN

Mar 13 2025 by T. P . VIGNESH, MBBS,MS

Fundus photograph of an 42-year-old man with familial dominant drusen.

Photographer: Sivanath

Imaging device: EIDON

Condition/keywords: Doyne's Honeycomb

Mar 6 2025 by Gerardo - Montante Montelongo, MD

Fundus photograph of an 83-year-old male with a history of Diabetes, smoking, cataract surgery on the right eye in 2022, and open-angle glaucoma. Asymptomatic. Indirect ophthalmoscopy revealed 80% excavation, peripapillary atrophy, and a hyperpigmented perifoveal lesion with 35% atrophy, 10% drusen, and 5.1 mm diameter, corresponding to a CHRPE. At multimodal imaging, FFA shows hypoautofluorescence of the lesion, OCT shows preservation of internal retinal layers, atrophy of external retinal layer, with an RPE disruption, and posterior shadowing. USG shows a flat hyperechoic lesion 5.1 mm in diameter and 1.32 mm in thickness, solid and with high internal reflectance.

Photographer: Gerardo Montante-Montelongo, MD, Mexican Institute of Ophthalmology

Imaging device: Clarus 700

Condition/keywords: congenital hypertrophy of the retinal pigment epithelium (CHRPE), multimodal imaging

Jan 2 2025 by Angela Rico

HD 1 line Raster OD in 33 y/o F with h/o Hereditary Retinal Dystrophy OU

Photographer: Angela Rico M.D.

Condition/keywords: drusen

Jan 2 2025 by Angela Rico

HD 1 line Raster OS in 33 y/o F with h/o Hereditary Retinal Dystrophy OU

Photographer: Angela Rico M.D.

Condition/keywords: drusen

Nov 30 2024 by John S. King, MD

Both right and left eyes have symmetrical ring of mottled hypo/hyper AF around the fovea and disc. The HyperAF areas correspond to RPE deposits on OCT as well as areas of blockage on FA, and drusenoid deposits seen on fundus photos 57 yo WF referred for AMD vs Pattern Dystrophy that was diagnosed 10 years ago. Reported some slow progressive vision loss in both eyes for distance and near. Denies nyctalopia or hemeralopia. Background medical history includes HTN, CVD, and DM. No family history of eye problems. Denied pentosan use. Anterior segment showed moderate cataracts (OD>OS). Posterior segment exam showed macular changes and mild NPDR. The macular appearance showed a symmetrical, paramacular ring of fleck-like drusenoid material with some faint focal areas of RPE hyperplasia. Fundus Photos, AF, OCT were performed as well as a gene test. Further questioning showed revealed that her mother and maternal grandmother had both diabetes mellitus and sensorineural hearing loss. The patient developed diabetes in her teens, and some high frequency hearing loss in her early twenties. She had not had a previous genetic test or diagnosis of MIDD. Gene testing is pending for the mitochondrial component. Invitae's retinal panel, which does not include mitochondrial disorders, only showed a variant of uncertain significance, HMCN1. I discussed this case with Dr. Freund, and it is similar to a the case report : Inoue M, Kiss S, Freund KB. MACULAR PIGMENT RINGS AS THE PRESENTING FINDING OF MITOCHONDRIAL MYOPATHY, ENCEPHALOPATHY, LACTIC ACIDOSIS, AND STROKELIKE EPISODES. Retin Cases Brief Rep. 2015 Fall;9(4):260-4. doi: 10.1097/ICB.0000000000000182. PMID: 26200388.

Photographer: Grace Melton and Carley Gunn

Imaging device: Clarus

Condition/keywords: Macular Dystrophy, Maternally Inherited Diabetes and Deafness, MIDD, Mitochondrial Disorder

Nov 30 2024 by John S. King, MD

Both right and left eyes have symmetrical ring of mottled hypo/hyper AF around the fovea and disc. The HyperAF areas correspond to RPE deposits on OCT as well as areas of blockage on FA, and drusenoid deposits seen on fundus photos. Disc drusen in right eye present as HyperAF spot 57 yo WF referred for AMD vs Pattern Dystrophy that was diagnosed 10 years ago. Reported some slow progressive vision loss in both eyes for distance and near. Denies nyctalopia or hemeralopia. Background medical history includes HTN, CVD, and DM. No family history of eye problems. Denied pentosan use. Anterior segment showed moderate cataracts (OD>OS). Posterior segment exam showed macular changes and mild NPDR. The macular appearance showed a symmetrical, paramacular ring of fleck-like drusenoid material with some faint focal areas of RPE hyperplasia. Fundus Photos, AF, OCT were performed as well as a gene test. Further questioning showed revealed that her mother and maternal grandmother had both diabetes mellitus and sensorineural hearing loss. The patient developed diabetes in her teens, and some high frequency hearing loss in her early twenties. She had not had a previous genetic test or diagnosis of MIDD. Gene testing is pending for the mitochondrial component. Invitae's retinal panel, which does not include mitochondrial disorders, only showed a variant of uncertain significance, HMCN1. I discussed this case with Dr. Freund, and it is similar to a the case report : Inoue M, Kiss S, Freund KB. MACULAR PIGMENT RINGS AS THE PRESENTING FINDING OF MITOCHONDRIAL MYOPATHY, ENCEPHALOPATHY, LACTIC ACIDOSIS, AND STROKELIKE EPISODES. Retin Cases Brief Rep. 2015 Fall;9(4):260-4. doi: 10.1097/ICB.0000000000000182. PMID: 26200388.

Photographer: Grace Melton and Carley Gunn

Imaging device: Clarus

Condition/keywords: Macular Dystrophy, Maternally Inherited Diabetes and Deafness, MIDD, Mitochondrial Disorder

Nov 30 2024 by John S. King, MD

Both the right and left Eye have fairly symmetrical, extrafoveal drusenoid-like flecks and focal and faint areas of RPE hyperplasia (in addition to mild NPDR and PPA) 57 yo WF referred for AMD vs Pattern Dystrophy that was diagnosed 10 years ago. Reported some slow progressive vision loss in both eyes for distance and near. Denies nyctalopia or hemeralopia. Background medical history includes HTN, CVD, and DM. No family history of eye problems. Denied pentosan use. Anterior segment showed moderate cataracts (OD>OS). Posterior segment exam showed macular changes and mild NPDR. The macular appearance showed a symmetrical, paramacular ring of fleck-like drusenoid material with some faint focal areas of RPE hyperplasia. Fundus Photos, AF, OCT were performed as well as a gene test. Further questioning showed revealed that her mother and maternal grandmother had both diabetes mellitus and sensorineural hearing loss. The patient developed diabetes in her teens, and some high frequency hearing loss in her early twenties. She had not had a previous genetic test or diagnosis of MIDD. Gene testing is pending for the mitochondrial component. Invitae's retinal panel, which does not include mitochondrial disorders, only showed a variant of uncertain significance, HMCN1. I discussed this case with Dr. Freund, and it is similar to a the case report : Inoue M, Kiss S, Freund KB. MACULAR PIGMENT RINGS AS THE PRESENTING FINDING OF MITOCHONDRIAL MYOPATHY, ENCEPHALOPATHY, LACTIC ACIDOSIS, AND STROKELIKE EPISODES. Retin Cases Brief Rep. 2015 Fall;9(4):260-4. doi: 10.1097/ICB.0000000000000182. PMID: 26200388.

Photographer: Grace Melton and Carley Gunn

Imaging device: Clarus

Condition/keywords: Macular Dystrophy, Maternally Inherited Diabetes and Deafness, MIDD, Mitochondrial Disorder

Nov 30 2024 by John S. King, MD

Both the right and left Eye have fairly symmetrical, extrafoveal drusenoid-like flecks and focal and faint areas of RPE hyperplasia (in addition to mild NPDR and PPA) 57 yo WF referred for AMD vs Pattern Dystrophy that was diagnosed 10 years ago. Reported some slow progressive vision loss in both eyes for distance and near. Denies nyctalopia or hemeralopia. Background medical history includes HTN, CVD, and DM. No family history of eye problems. Denied pentosan use. Anterior segment showed moderate cataracts (OD>OS). Posterior segment exam showed macular changes and mild NPDR. The macular appearance showed a symmetrical, paramacular ring of fleck-like drusenoid material with some faint focal areas of RPE hyperplasia. Fundus Photos, AF, OCT were performed as well as a gene test. Further questioning showed revealed that her mother and maternal grandmother had both diabetes mellitus and sensorineural hearing loss. The patient developed diabetes in her teens, and some high frequency hearing loss in her early twenties. She had not had a previous genetic test or diagnosis of MIDD. Gene testing is pending for the mitochondrial component. Invitae's retinal panel, which does not include mitochondrial disorders, only showed a variant of uncertain significance, HMCN1. I discussed this case with Dr. Freund, and it is similar to a the case report : Inoue M, Kiss S, Freund KB. MACULAR PIGMENT RINGS AS THE PRESENTING FINDING OF MITOCHONDRIAL MYOPATHY, ENCEPHALOPATHY, LACTIC ACIDOSIS, AND STROKELIKE EPISODES. Retin Cases Brief Rep. 2015 Fall;9(4):260-4. doi: 10.1097/ICB.0000000000000182. PMID: 26200388.

Photographer: Grace Melton and Carley Gunn

Imaging device: Clarus

Condition/keywords: Macular Dystrophy, Maternally Inherited Diabetes and Deafness, MIDD, Mitochondrial Disorder

Nov 30 2024 by John S. King, MD

OCT shows mild RPE deposit inferiorly (corresponds to area of FA blockage and HyperAF) and a focal area of iRORA with loss of EZ more superiorly (possibly due to regression of RPE deposit). No choroidal thickening (like in pachychoroid pigment epitheliopathy or cscr) 57 yo WF referred for AMD vs Pattern Dystrophy that was diagnosed 10 years ago. Reported some slow progressive vision loss in both eyes for distance and near. Denies nyctalopia or hemeralopia. Background medical history includes HTN, CVD, and DM. No family history of eye problems. Denied pentosan use. Anterior segment showed moderate cataracts (OD>OS). Posterior segment exam showed macular changes and mild NPDR. The macular appearance showed a symmetrical, paramacular ring of fleck-like drusenoid material with some faint focal areas of RPE hyperplasia. Fundus Photos, AF, OCT were performed as well as a gene test. Further questioning showed revealed that her mother and maternal grandmother had both diabetes mellitus and sensorineural hearing loss. The patient developed diabetes in her teens, and some high frequency hearing loss in her early twenties. She had not had a previous genetic test or diagnosis of MIDD. Gene testing is pending for the mitochondrial component. Invitae's retinal panel, which does not include mitochondrial disorders, only showed a variant of uncertain significance, HMCN1. I discussed this case with Dr. Freund, and it is similar to a the case report : Inoue M, Kiss S, Freund KB. MACULAR PIGMENT RINGS AS THE PRESENTING FINDING OF MITOCHONDRIAL MYOPATHY, ENCEPHALOPATHY, LACTIC ACIDOSIS, AND STROKELIKE EPISODES. Retin Cases Brief Rep. 2015 Fall;9(4):260-4. doi: 10.1097/ICB.0000000000000182. PMID: 26200388.

Photographer: Grace Melton and Carley Gunn

Imaging device: Zeiss Cirrus

Condition/keywords: Macular Dystrophy, Maternally Inherited Diabetes and Deafness, MIDD, Mitochondrial Disorder

Nov 30 2024 by John S. King, MD

Magnified section of radial scan through the left eye showing a focal nodular RPE deposit that corresponds to a focal drusenoid deposit in temporal macula, that HypoFLs and HyperAFs. Choroid not significantly thickened or thinned, and the nodular thickening may be just above a large outer choroid vessel?) 57 yo WF referred for AMD vs Pattern Dystrophy that was diagnosed 10 years ago. Reported some slow progressive vision loss in both eyes for distance and near. Denies nyctalopia or hemeralopia. Background medical history includes HTN, CVD, and DM. No family history of eye problems. Denied pentosan use. Anterior segment showed moderate cataracts (OD>OS). Posterior segment exam showed macular changes and mild NPDR. The macular appearance showed a symmetrical, paramacular ring of fleck-like drusenoid material with some faint focal areas of RPE hyperplasia. Fundus Photos, AF, OCT were performed as well as a gene test. Further questioning showed revealed that her mother and maternal grandmother had both diabetes mellitus and sensorineural hearing loss. The patient developed diabetes in her teens, and some high frequency hearing loss in her early twenties. She had not had a previous genetic test or diagnosis of MIDD. Gene testing is pending for the mitochondrial component. Invitae's retinal panel, which does not include mitochondrial disorders, only showed a variant of uncertain significance, HMCN1. I discussed this case with Dr. Freund, and it is similar to a the case report : Inoue M, Kiss S, Freund KB. MACULAR PIGMENT RINGS AS THE PRESENTING FINDING OF MITOCHONDRIAL MYOPATHY, ENCEPHALOPATHY, LACTIC ACIDOSIS, AND STROKELIKE EPISODES. Retin Cases Brief Rep. 2015 Fall;9(4):260-4. doi: 10.1097/ICB.0000000000000182. PMID: 26200388.

Photographer: Grace Melton and Carley Gunn

Imaging device: Zeiss Cirrus

Condition/keywords: Macular Dystrophy, Maternally Inherited Diabetes and Deafness, MIDD, Mitochondrial Disorder

Nov 30 2024 by John S. King, MD

Both eyes had similar FA findings. There was no dark choroid or signs of leakage. Granular staining around the fovea and disc were present, and the HypoAF areas corresponded to the drusenoid deposits that showed HyperAF. Mild MAs present due to NPDR 57 yo WF referred for AMD vs Pattern Dystrophy that was diagnosed 10 years ago. Reported some slow progressive vision loss in both eyes for distance and near. Denies nyctalopia or hemeralopia. Background medical history includes HTN, CVD, and DM. No family history of eye problems. Denied pentosan use. Anterior segment showed moderate cataracts (OD>OS). Posterior segment exam showed macular changes and mild NPDR. The macular appearance showed a symmetrical, paramacular ring of fleck-like drusenoid material with some faint focal areas of RPE hyperplasia. Fundus Photos, AF, OCT were performed as well as a gene test. Further questioning showed revealed that her mother and maternal grandmother had boith diabetes mellitus and sensorineural hearing loss. The patient developed diabetes in her teens, and some high frequency hearing loss in her early twenties. She had not had a previous genetic test or diagnosis of MIDD. Gene testing is pending for the mitochondrial component. Invitae's retinal panel, which does not include mitochondrial disorders, only showed a variant of uncertain significance, HMCN1. I discussed this case with Dr. Freund, and it is similar to a the case report : Inoue M, Kiss S, Freund KB. MACULAR PIGMENT RINGS AS THE PRESENTING FINDING OF MITOCHONDRIAL MYOPATHY, ENCEPHALOPATHY, LACTIC ACIDOSIS, AND STROKELIKE EPISODES. Retin Cases Brief Rep. 2015 Fall;9(4):260-4. doi: 10.1097/ICB.0000000000000182. PMID: 26200388.

Photographer: Grace Melton and Carley Gunn

Imaging device: Clarus

Condition/keywords: Macular Dystrophy, Maternally Inherited Diabetes and Deafness, MIDD, Mitochondrial Disorder

Nov 30 2024 by John S. King, MD

Both eyes had similar FA findings. There was no dark choroid or signs of leakage. Granular staining around the fovea and disc were present, and the HypoAF areas corresponded to the drusenoid deposits that showed HyperAF. Mild MAs present due to NPDR 57 yo WF referred for AMD vs Pattern Dystrophy that was diagnosed 10 years ago. Reported some slow progressive vision loss in both eyes for distance and near. Denies nyctalopia or hemeralopia. Background medical history includes HTN, CVD, and DM. No family history of eye problems. Denied pentosan use. Anterior segment showed moderate cataracts (OD>OS). Posterior segment exam showed macular changes and mild NPDR. The macular appearance showed a symmetrical, paramacular ring of fleck-like drusenoid material with some faint focal areas of RPE hyperplasia. Fundus Photos, AF, OCT were performed as well as a gene test. Further questioning showed revealed that her mother and maternal grandmother had boith diabetes mellitus and sensorineural hearing loss. The patient developed diabetes in her teens, and some high frequency hearing loss in her early twenties. She had not had a previous genetic test or diagnosis of MIDD. Gene testing is pending for the mitochondrial component. Invitae's retinal panel, which does not include mitochondrial disorders, only showed a variant of uncertain significance, HMCN1. I discussed this case with Dr. Freund, and it is similar to a the case report : Inoue M, Kiss S, Freund KB. MACULAR PIGMENT RINGS AS THE PRESENTING FINDING OF MITOCHONDRIAL MYOPATHY, ENCEPHALOPATHY, LACTIC ACIDOSIS, AND STROKELIKE EPISODES. Retin Cases Brief Rep. 2015 Fall;9(4):260-4. doi: 10.1097/ICB.0000000000000182. PMID: 26200388.

Photographer: Grace Melton and Carley Gunn

Imaging device: Clarus

Condition/keywords: Macular Dystrophy, Maternally Inherited Diabetes and Deafness, MIDD, Mitochondrial Disorder

Nov 19 2024 by Rafael Robbs

Fundus Autofluorescence: presence of optic disc drusen, associated with angioid streaks, in a patient with pseudoxanthoma elasticum.

Photographer: Rafael Robbs, Universidade Federal Fluminense, Niterói Rio de Janeiro, Brazil

Imaging device: DRI OCT-1 Triton / Triton Plus

Condition/keywords: angioid streaks, optic disc drusen, pseudoxanthoma elasticum (PXE)

Oct 30 2024 by JULIAN VILLARREAL, MD

FAF showing angiod streaks , optic disc drusen, and macular atrophy secondary to macular neovascular membrane.

Photographer: Julián Villarreal MD

Imaging device: Mirante

Condition/keywords: Angioid Streaks, macular atrophy, optic disc drusen

Aug 8 2024 by Hemanth Murthy, MBBS, MD, FASRS

Multicolor image of left eye of 53 year female patient with decreased vision in left eye. Patient gives history of multiple joint swellings with multiple dental procedures due to calcification of the roots. She had type2 MNV demonstrated on OCT and OCTA. Her blood reports showed elevated serum phosphorus (6.4 mg/dl) with normal serum calcium, vitamin D and parathyroid hormone. Her fibroblast growth factor 23 was markedly elevated(>1500RU/ml).

Photographer: Mr Veda Vyas

Condition/keywords: Optic disc drusen and Angiod streaks

Aug 8 2024 by Hemanth Murthy, MBBS, MD, FASRS

Multicolor image of right eye of 53 year female patient with decreased vision in left eye. Patient gives history of multiple joint swellings with multiple dental procedures due to calcification of the roots. She showed type2 MNV on OCT and OCTA. Her blood reports showed elevated serum phosphorus (6.4 mg/dl) with normal serum calcium, vitamin D and parathyroid hormone. Her fibroblast growth factor 23 was markedly elevated(>1500RU/ml).

Photographer: Mr Veda Vyas

Condition/keywords: Optic disc drusen and Angiod streaks

Aug 8 2024 by Hemanth Murthy, MBBS, MD, FASRS

Autofluorescence image of left eye of 53 year female patient with decreased vision in left eye. Patient gives history of multiple joint swellings with multiple dental procedures due to calcification of the roots. She showed type 2 MNV in left eye on OCT and OCTA. Her blood reports showed elevated serum phosphorus (6.4 mg/dl) with normal serum calcium, vitamin D and parathyroid hormone. Her fibroblast growth factor 23 was markedly elevated(>1500RU/ml).

Photographer: Mr Veda Vyas

Condition/keywords: Optic disc drusen and Angiod streaks

Aug 8 2024 by Hemanth Murthy, MBBS, MD, FASRS

Autofluorescence image of right eye of 53 year female patient with decreased vision in left eye. Patient gives history of multiple joint swellings with multiple dental procedures due to calcification of the roots. She had type2 MNV in left eye demonstrated on OCT and OCTA. Her blood reports showed elevated serum phosphorus (6.4 mg/dl) with normal serum calcium, vitamin D and parathyroid hormone. Her fibroblast growth factor 23 was markedly elevated(>1500RU/ml).

Photographer: Mr Veda Vyas

Condition/keywords: Optic disc drusen and Angiod streaks

May 31 2024 by Akshat Tyagi

OD fundus photograph of a 45-year-old man with multiple drusen distributed all over the posterior pole in both eyes. BCVA was 6/6 OU.

Photographer: Akshat Tyagi

Imaging device: Huvitz HOCT-1

Condition/keywords: Drusen, FAMILIAL DOMINANT DRUSEN

May 28 2024 by Nishikant J Borse, MS, FMRF, FASRS

65-year-old female was referred for disc edema. An Autofluorescence Imaging was done which showed the autofluorescence of the optic nerve head drusen.

Photographer: Dr Nishikant Borse , Insight eye Clinic , Mumbai

Imaging device: Topcon Triton

Condition/keywords: Autofluorescence imaging of Optic Disc Drusen

May 28 2024 by Nishikant J Borse, MS, FMRF, FASRS

65-year-old female was referred for disc edema. An Autofluorescence Imaging was done which showed the autofluorescence of the optic nerve head drusen.

Photographer: Dr Nishikant Borse , Insight eye Clinic , Mumbai

Imaging device: Topcon Triton

Condition/keywords: Autofluorescence imaging of Optic Disc Drusen