Acute Zonal Cone Photoreceptor Outer Segment Loss

Tomas S. Aleman, Harpal S. Sandhu, Leona W. Serrano, Anastasia Traband, Marisa K. Lau, Grazyna Adamus, Robert A. Avery

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Importance: The diagnostic path presented narrows down the cause of acute vision loss to the cone photoreceptor outer segment and will refocus the search for the cause of similar currently idiopathic conditions.

Objective: To describe the structural and functional associations found in a patient with acute zonal occult photoreceptor loss.

Design, Setting, and Participants: A case report of an adolescent boy with acute visual field loss despite a normal fundus examination performed at a university teaching hospital.

Main Outcomes and Measures: Results of a complete ophthalmic examination, full-field flash electroretinography (ERG) and multifocal ERG, light-adapted achromatic and 2-color dark-adapted perimetry, and microperimetry. Imaging was performed with spectral-domain optical coherence tomography (SD-OCT), near-infrared (NIR) and short-wavelength (SW) fundus autofluorescence (FAF), and NIR reflectance (REF).

Results: The patient was evaluated within a week of the onset of a scotoma in the nasal field of his left eye. Visual acuity was 20/20 OU, and color vision was normal in both eyes. Results of the fundus examination and of SW-FAF and NIR-FAF imaging were normal in both eyes, whereas NIR-REF imaging showed a region of hyporeflectance temporal to the fovea that corresponded with a dense relative scotoma noted on light-adapted static perimetry in the left eye. Loss in the photoreceptor outer segment detected by SD-OCT co-localized with an area of dense cone dysfunction detected on light-adapted perimetry and multifocal ERG but with near-normal rod-mediated vision according to results of 2-color dark-adapted perimetry. Full-field flash ERG findings were normal in both eyes. The outer nuclear layer and inner retinal thicknesses were normal.

Conclusions and Relevance: Localized, isolated cone dysfunction may represent the earliest photoreceptor abnormality or a distinct entity within the acute zonal occult outer retinopathy complex. Acute zonal occult outer retinopathy should be considered in patients with acute vision loss and abnormalities on NIR-REF imaging, especially if multimodal imaging supports an intact retinal pigment epithelium and inner retina but an abnormal photoreceptor outer segment.

Original languageEnglish (US)
Pages (from-to)487-490
Number of pages4
JournalJAMA Ophthalmology
Volume135
Issue number5
DOIs
StatePublished - May 1 2017

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Retinal Cone Photoreceptor Cells
Electroretinography
Visual Field Tests
Scotoma
Optical Coherence Tomography
Light
Color
Night Vision
Multimodal Imaging
Color Vision
Retinal Pigment Epithelium
Optical Imaging
Temporal Lobe
Visual Fields
Nose
Teaching Hospitals
Visual Acuity
Retina
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Aleman, T. S., Sandhu, H. S., Serrano, L. W., Traband, A., Lau, M. K., Adamus, G., & Avery, R. A. (2017). Acute Zonal Cone Photoreceptor Outer Segment Loss. JAMA Ophthalmology, 135(5), 487-490. https://doi.org/10.1001/jamaophthalmol.2017.0451

Acute Zonal Cone Photoreceptor Outer Segment Loss. / Aleman, Tomas S.; Sandhu, Harpal S.; Serrano, Leona W.; Traband, Anastasia; Lau, Marisa K.; Adamus, Grazyna; Avery, Robert A.

In: JAMA Ophthalmology, Vol. 135, No. 5, 01.05.2017, p. 487-490.

Research output: Contribution to journalArticle

Aleman, TS, Sandhu, HS, Serrano, LW, Traband, A, Lau, MK, Adamus, G & Avery, RA 2017, 'Acute Zonal Cone Photoreceptor Outer Segment Loss', JAMA Ophthalmology, vol. 135, no. 5, pp. 487-490. https://doi.org/10.1001/jamaophthalmol.2017.0451
Aleman TS, Sandhu HS, Serrano LW, Traband A, Lau MK, Adamus G et al. Acute Zonal Cone Photoreceptor Outer Segment Loss. JAMA Ophthalmology. 2017 May 1;135(5):487-490. https://doi.org/10.1001/jamaophthalmol.2017.0451
Aleman, Tomas S. ; Sandhu, Harpal S. ; Serrano, Leona W. ; Traband, Anastasia ; Lau, Marisa K. ; Adamus, Grazyna ; Avery, Robert A. / Acute Zonal Cone Photoreceptor Outer Segment Loss. In: JAMA Ophthalmology. 2017 ; Vol. 135, No. 5. pp. 487-490.
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