Optometry case study: Fundus albipunctutatus

1950

by Amy Fang, Fountain Gate, Melbourne, Australia

History and Examination

Two sisters presented for routine eye examinations, it was their first time in this practice.

Sister 1: 23 years old
Reason for visit – routine check – wants new glasses and to try contact lenses
POH – none
FOH – none

Sister 2: 18 years old
Reason for visit – routine check – wants new glasses
POH – none
FOH – none

Examination
Sister 1:
RE: -2.00 VA 6/6
LE: -1.75/-0.25 x 55 VA 6/6
External eye – normal

Sister 2:
RE: -1.50/-2.25 x 20 VA 6/6
LE: -1.00/-2.25 x 165 VA 6/6
External eye – normal

Digital retinal photography

Sister 1:

 

 

 

Sister 2:

 

 

 

Diagnosis

Differential diagnoses and their characteristics

• familial dominant drusen

This is an early onset variant of AMD characterised by macular drusen developing in the 2nd decade.

• fundus flavimaculatis

Characterised by accumulation of lipofuscin within the RPE in the macular area. Presents in 1st-2nd decade with bilateral gradual visual impairment.

• retinitis punctate albescens

Characterised by drusen in the retinal mid-periphery and periphery. The macula is spared in the early stages of the disease. Sometimes considered a variant of fundus albipunctatus but is more progressive in nature.

• fundus albipunctatus

One of a group of disorders characterised by non-progressive, infantile onset, night blindness. The retina shows many small white-yellow spots sparing the fovea but extending to the periphery. Visual field testing shows no loss.

Diagnosis and management
These sisters were diagnosed with fundus albipunctatus. No treatment was required and they are under biennial review in community optometric practice.

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