Adult Vitelliform Lesion with PED

This is a montage of images from an 86-year-old female patient with adult vitelliform dystrophy, a form of macular pattern dystrophy. Images have been collected over a 9-year follow up illustrating the natural history of the disease. As is often the case in this condition, the presentation is asymmetric. The right eye has a more prominent lesion than the left eye. In 2010, the adult vitelliform lesion (AVL) has a component above (yellow arrow) and a component below (red arrow) the retinal pigment epithelium (RPE). The component above the RPE is hypoerreflective, whereas some of the sub-RPE material is hyporeflective. By 2014 the RPE line is difficult to discern in the vertical scan (yellow arrow), but there is a clear pigment epithelial detachment in the horizontal scan (red arrow). By 2019 the ellipsoid zone has been lost indicating photoreceptor dropout, and the RPE is irregularly present. The left eye has an enlarged AVL by this point and can be expected to evolve further to RPE atrophy in several more years. The corrected visual acuities for these visits were 20/32, 20/20, and 20/40 in 2010, 2014, and 2019, respectively.