A 75-year-old female patient with progressive vision loss in both eyes was examined in our clinic.
Diabetes mellitus (-) Systemic hypertension (-) Family history (-) Smoking (-)
Best corrected visual acuity was 3/10 in both eyes. Intraocular pressure was 18 mmHg in both eyes. Anterior segment examination was unremarkable. Fundus examination revealed vitelliform, circular, foveal lesions in both eyes.
Color fundus photographs show bilateral, vitelliform, circular, foveal lesions (Figure 1).
Fundus autofluorescence imaging shows central hypoautofluorescence surrounded by a ring of hyperfluorescence (Figure 2).
SD-OCT imaging shows a subretinal hyperreflective dome-shaped lesion (Figure 3).
Adult-onset Foveomacular Dystrophy
It was first described by Gass in 1974. An autosomal dominant inheritance is suggested, however adult-onset foveomacular dystrophy can also be sporadic without evidence of a familial inheritance pattern. Mutations in the genes PRPH2, BEST1, IMPG1 and IMPG1 have been found in some individuals with adult-onset foveomacular dystrophy. There is an abnormal accumulation of lipofuscin. As a result, the RPE layer is separated from the photoreceptor layer by hyper-reflective material. Adult-onset vitelliform dystrophy is divided into four distinct stages. They are: vitelliform, pseudohypopyon, vitelliruptive and atrophic. As the disease progresses, ellipsoid zone damage and vision loss occur.
Best vitelliform macular dystrophy, Stargardt disease, central areolar choroidal dystrophy
Currently there is no approved treatment for adult-onset foveomacular dystrophy.
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Querques G, Forte R, Querques L, Massamba N, Souied EH. Natural course of adult-onset foveomacular vitelliform dystrophy: a spectral-domain optical coherence tomography analysis. Am J Ophtalmol 2011;152:304-313. https://pubmed.ncbi.nlm.nih.gov/21664595/
Chowers I, Tiosano L, Audo I, Grunin M, Boon CJF. Adult-onset foveomacular vitelliform dystrophy: a fresh perspective. Progress in Retinal and Eye Research 2015;47:64-85. https://pubmed.ncbi.nlm.nih.gov/25681578/