Grand Rounds

A patient with past medical history of CAD presented to our office with bilateral blurry vision and visual distortions. Visual acuity was 20/100 in the right eye and 20/20 in the left. On slit lamp examination, anterior segment was unremarkable. Fundus exam showed bilateral angioid streaks radiating off the optic nerve, nasal macular and foveal atrophy in the right eye, retinal pigment epithelium mottling in both eyes. Fundus autofluorescence showed hypo-autofluorescence correlating with the area of retinal atrophy in the right eye, confluent area of hyper and hypo autofluorescence in the macula of both eyes. OCT revealed ellipsoid and outer retinal loss and increased light penetrance through RPE in the right more than left eye. A diagnosis of pseudoxanthoma elasticum was made and observation was recommended. On annual follow up, patient reported no changes in symptoms, however, visual acuity was found to be one line worse in the left eye. OCT demonstrated inner retinal cysts and sub-retinal fluid. At 6-week follow-up, OCT-Angiography revealed a choroidal neovascular membrane in the left eye. Anti-VEGF was offered to the patient, but she declined given she remained asymptomatic.

Presentation Date: 10/01/2026
Issue Date: 10/02/2026