Bilateral Central and Peripheral Vision Loss in an Otherwise Asymptomatic Woman

A 65-year-old woman was referred for symptoms of painless and progressive bilateral loss of central and peripheral vision over the last 6 months, associated with floaters in the left eye. The patient reported difficulty in performing essential daily tasks, such as driving and walking without assistance. She denied photopsias. Her previous ocular and medical history were unremarkable. She denied any systemic symptoms as well as any family history of inherited ocular diseases.

On examination, best-corrected visual acuity was 20/32 OU. Fundus examination results showed attenuated arterial and venous retinal vessels and slight retinal pigmented epithelium changes at the posterior pole, consisting of atrophy and pigment migration in both eyes, associated with vitreous opacities in the left eye. Fluorescein angiography examination results showed a mild leakage of arterial and venous retinal vasculature (Figure). Spectral-domain optical coherence tomography exhibited disruption at the photoreceptor level and multifocal hyperreflective material depositions at the retinal pigmented epithelium level.