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Ophthalmology

Bilateral Macular Schisis in a Woman

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Ophthalmology

Published Online: May 27, 2021

JAMA Ophthalmology Clinical Challenge

Article Information and Disclosures

Nita G. Valikodath, MD, MS¹;

Nicole K. Scripsema, MD¹;

Jennifer I. Lim, MD^1,2

Author Affiliations

¹Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago
²Associate Deputy Editor, JAMA Ophthalmology

Read article on JAMA Network

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A 64-year-old woman in excellent general health who was not taking any medications was referred for evaluation of an epiretinal membrane of her right eye. She reported no blurry vision, metamorphopsia, photopsias, floaters, or nyctalopia, and she had no history of refractive surgical procedures, ocular surgical procedures, or trauma. Her family history was negative for ocular conditions, and there was no consanguinity in her family.

Her visual acuity was 20/20 OU with correction (plano +0.25 × 153 OD and −0.50 + 0.25 × 009 OS). External and anterior segment examination results were unremarkable except for mild nuclear sclerotic cataracts. Results of a dilated ophthalmoscopic examination showed radial spokelike striae of the fovea, with a central cyst in the right eye and macular edema of the left eye. Optical coherence tomography (OCT) imaging of the right macula showed cystlike changes in the outer retina in the foveal and parafoveal regions and in the inner retina in the temporal macula. Optical coherence tomography imaging of the left macula showed cystlike changes in the outer retina in the inferior macula (Figure). Of note, OCT scans of the optic nerves did not reveal an optic disc pit.

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A 64-year-old woman in excellent general health who was not taking any medications was referred for evaluation of an epiretinal membrane of her right eye. She reported no blurry vision, metamorphopsia, photopsias, floaters, or nyctalopia, and she had no history of refractive surgical procedures, ocular surgical procedures, or trauma. Her family history was negative for ocular conditions, and there was no consanguinity in her family.

Her visual acuity was 20/20 OU with correction (plano +0.25 × 153 OD and −0.50 + 0.25 × 009 OS). External and anterior segment examination results were unremarkable except for mild nuclear sclerotic cataracts. Results of a dilated ophthalmoscopic examination showed radial spokelike striae of the fovea, with a central cyst in the right eye and macular edema of the left eye. Optical coherence tomography (OCT) imaging of the right macula showed cystlike changes in the outer retina in the foveal and parafoveal regions and in the inner retina in the temporal macula. Optical coherence tomography imaging of the left macula showed cystlike changes in the outer retina in the inferior macula (Figure). Of note, OCT scans of the optic nerves did not reveal an optic disc pit.

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Article Information

Corresponding Author: Jennifer I. Lim, MD, Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, 1855 W Taylor St, Ste 2.50, Mail Code 648, Chicago, IL 60612 (jennylim@uic.edu).

Published Online: May 27, 2021. doi:10.1001/jamaophthalmol.2020.5292

Conflict of Interest Disclosures: Dr Lim reported receiving grants from Aldeyra, Chengdu, Clearside, Genentech, Graybug, Janssen, NGM, Regeneron, and Stealth and personal fees from Alcon, Allergan, Aura Biosciences, Cognition Therapeutics, Eyenuk, Genentech, Iveric Biosciences, Kodiak, Luxa, Novartis, Ophthea, pSivida (now EyePoint Pharmaceuticals, Inc), Quark, and Santen outside of the submitted work.

Disclaimer: Dr Lim is an Associate Deputy Editor of JAMA Ophthalmology, but she was not involved in any of the decisions regarding review of the manuscript or its acceptance.

Additional Contributions: We thank the patient for granting permission to publish this information.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.