Consultant Ophthalmologist
A clinical log for optometrists and eye care professionals.
Cases are drawn from NHS and private medical retina practice in Brighton, covering a range of conditions encountered in routine optometry referrals and emergency eye care. Each case includes OCT interpretation, differential diagnosis and management.
A 64-year-old woman is referred with an abnormal right macular OCT. The findings are diagnostic of torpedo maculopathy - a rare congenital RPE anomaly. An incidental longstanding peripheral retinal tear is also identified in the left eye, requiring no treatment.
Read case →A 77-year-old woman is referred with a vitelliform-like left macular lesion on OCT. Near-infrared fundus imaging of both eyes reveals a characteristic cruciform pigment pattern - diagnostic of butterfly-shaped pattern dystrophy, and a reminder that the image beside the OCT is sometimes the most important one.
Read case →A 27-year-old man is referred after his first OCT reveals an area of apparent RPE absence inferonasal to the right optic disc. The appearance is typical of a conforming focal choroidal excavation - a rare but benign idiopathic finding. Remote diagnosis allowed reassurance without a hospital visit.
Read case →An 87-year-old woman is referred urgently with a working diagnosis of vitelliform macular dystrophy and dot and blot haemorrhages. OCT and careful fundus interpretation point instead to a single unifying diagnosis: an old superotemporal BRVO with secondary ERM and an acquired vitelliform lesion at the fovea.
Read case →A 57-year-old woman is referred with a growing left macular lesion and a hypermetropic shift in visual acuity. Serial OCT demonstrates interval growth of a choroidal lesion with an overlying serous PED, raising a broad differential that includes circumscribed choroidal haemangioma, CSCR spectrum disease, and choroidal melanoma.
Read case →A 52-year-old asymptomatic man is referred after his first macular OCT reveals a raised area temporal to the fovea. The imaging is typical of a choroidal macrovessel - a benign anomalous dilated choroidal vessel that can mimic more sinister pathology. Confident remote interpretation allowed reassurance without a hospital visit.
Read case →A 43-year-old man with schizophrenia on long-term aripiprazole presents with bilateral subretinal fluid presumed to be CSCR. Drug history reveals a recognised but rare antipsychotic association, and a complex risk-benefit discussion with his psychiatrist determines that medication cannot be withdrawn.
Read case →An 83-year-old woman with no visual symptoms is found to have a peripapillary haemorrhage and subretinal lesion on left OCT at a routine sight test. The imaging points to an active peripapillary choroidal neovascular membrane - a diagnosis that hinges on OCT and careful consideration of the differential.
Read case →A 64-year-old woman is found to have a right full-thickness macular hole at a routine sight test, with no preceding visual symptoms. Bilateral OCT confirms the diagnosis and reveals a left posterior vitreous detachment - reassuring for the fellow eye and a prompt for direct referral to the vitreoretinal team.
Read case →A 40-year-old woman wakes from elective endovascular coiling of a paraophthalmic ICA aneurysm with no perception of light in the left eye. Serial OCT over three months illustrates the acute and chronic phases of central retinal artery occlusion, with apparent cilioretinal artery sparing but NPL vision raising the possibility of concurrent ischaemic optic neuropathy.
Read case →A 57-year-old man is referred having carried a diagnosis of early-onset dry AMD since his late thirties. The age of onset alone is enough to question the label - and the imaging raises a broad differential including dominant drusen, pachychoroid drusen, and inherited macular dystrophy.
Read case →A 57-year-old man with longstanding CSCR and 18 prior bevacizumab injections is reviewed with ongoing disease activity. Multimodal imaging including FFA, ICG, OCT angiography and structural OCT confirms pachychoroid neovasculopathy - a distinct entity within the pachychoroid spectrum - and guides a switch to aflibercept with good treatment response.
Read case →A 58-year-old man with a six-month history of a central dark patch in his left eye. OCT, fundus photography and fluorescein angiography confirm chronic CSCR, treated with photodynamic therapy.
Read case →A 42-year-old woman attending a virtual OCT clinic for diabetic macular oedema monitoring. The scan for oedema is clear — but closer inspection reveals pre-retinal neovascularisation, requiring urgent PRP laser on the same day.
Read case →A 29-year-old man with bilateral central blurring. OCT reveals bilateral hyperreflective bands in the inner nuclear layer — characteristic of paracentral acute middle maculopathy.
Read case →A 62-year-old man referred for 'cystoid macular oedema' is found to have microcystic macular oedema on OCT — a sign of retrograde retinal change secondary to a previous ischaemic optic neuropathy.
Read case →A 69-year-old woman with sudden onset of a paracentral scotoma. OCT and infrared imaging confirm acute macular neuroretinopathy, with partial resolution at two months.
Read case →A 60-year-old woman on long-term hydroxychloroquine for lupus is found to have bilateral parafoveal outer retinal loss on routine OCT — a reminder of the importance of screening guidelines.
Read case →A 35-year-old man with sudden bilateral central visual disturbance. OCT shows bilateral ellipsoid zone disruption at the fovea — caused by alkyl nitrite ('poppers') use the previous night.
Read case →A 59-year-old man seen routinely after left cataract surgery is found to have a small sub-ILM haemorrhage nasal to the fovea. The OCT appearance and differential diagnosis are discussed.
Read case →A 52-year-old lady referred for a left epiretinal membrane. Good acuity and absence of symptoms meant surgical intervention was not indicated — and a direct optometrist-to-consultant email saved a clinic appointment.
Read case →A 47-year-old asymptomatic woman with bilateral, multiple pigment epithelial detachments found at a routine sight test — a rare variant of central serous chorioretinopathy.
Read case →A 63-year-old man with one week of pixelated central vision. Serial OCT scans document the natural history of a branch retinal vein occlusion, from oedema through to ischaemic thinning.
Read case →An 84-year-old lady with a progressive dark spot in her right eye. OCT shows subretinal fluid and hyperreflective material at the fovea — typical of neovascular AMD.
Read case →