Clinical Review & Education JAMA Ophthalmology Clinical Challenge Kristen H. Nwanyanwu, MD; Jennifer I. Lim, MD Figure 1. Fundus photograph shows yellow-white, multisized, subretinal, creamy lesions in the right eye. A 49-year-old woman noticed a “smudge” in the central vision of her right eye with asso- ciated photopsias. On examination, visual acuity measured 20/50 OD. Her local ophthal- WHAT WOULD YOU DO NEXT? mologist considered a white dot syndrome and recommended a systemic workup. Results of a complete blood cell count, comprehensive metabolic panel, antinuclear antibodies (in- A. Observation cluding DNA and ribosomal SSA/Ro), positron emission tomography and magnetic reso- nance imaging (MRI) of the brain, mammography, and B. Oral corticosteroid chest radiography were normal. Dermatologic exami- Quiz at nation revealed a nevus on the left arm, a nevus on her C. Vitreous biopsy jamaophthalmology.com left shoulder, and seborrheic keratosis on her left shoul- der. Three months later, at the Illinois Eye and Ear Infir- D. Extended workup mary, she reported an improvement in her vision but noted negative images of dots when her right eye was closed. Review of systems was negative. Visual acuities measured 20/30 OD and 20/20 OS. Slitlamp examination findings were normal; there were no
JAMA Ophthalmology – American Medical Association
Published: Dec 1, 2013
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