Stargardt Disease - Atrophic Macular Lesion Plus Flecks

Fundus images of a man with Stargardt Disease in which atrophic, "beaten metal" macular lesions are present bilaterally, as well as perimacular subretinal tan lipofuscin flecks. There are many phenotypes within the same diagnosis of Stargardt Disease. The visual acuity was 20/50 right, 20/25 left when these photographs were taken. It is not unusual for a patient to show relatively good visual acuity despite a dramatically damaged appearance of the maculas. Within one year the visual acuity of the right eye had fallen to counting fingers, but the left eye remained 20/25. It is also not rare for the reverse to occur - where visual acuity is disproportionately poor relative to a fairly normal macular appearance. In fact, a clinical pearl is to suspect Stargardt Disease in a young person with unexplained bilateral central visual loss.