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45-year-old man was seen in the office on 1-29-08. He had muscle surgery when he was a child for strabismus. He does not, to his knowledge, have any problem with amblyopia. He noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay. VISUAL ACUITY: OD: 20/20; OS: 20/40. IOP: OS: 16, OS: 15. Color vision: 8/10 correct in each eye. Slit Lam Exam: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There is a nevus inferior to the fovea. OS: Vertical C/D ratio is 0.1. There is 1+ vitreous cells. The optic nerve is pink. There are peripheral bone spicules extending from 9:00 around to 6:00 sparing the macula. Photos confirm clinical findings. A fluorescein angiogram shows typical hyperfluorescence and window defects in the areas of the bone spicules, which are only present in the left eye and spare the macula, as you would expect in a patient with retinitis pigmentosa. IMPRESSION: 1. PERIPHERAL BONE SPICULES IN THE LEFT EYE. 2. POSSIBLY UNILATERAL RETINITIS PIGMENTOSA. 3. PROBABLE ACUTE ZONAL OCCULT OUTER RETINOPATHY. DISCUSSION: I explained to the patient that the signs in the left eye are consistent with retinitis pigmentosa, however this is typically a bilateral disease. There are reported cases in the literature of unilateral retinitis pigmentosa, but most of these pre-date the description of AZOOR, which has findings similar to that seen in retinitis pigmentosa. This patient’s eye is slightly different than most AZOOR eyes I have seen in that the patches of bone spicules in the left eye are in the periphery as you would expect in patients with retinitis pigmentosa. It is interesting, though, that the inferonasal quadrant is spared in the left eye. The only infectious disease I ordered blood tests for is syphilis, to rule that out. I asked him to return here for a check in three to four months, sooner should he notice any problem, and to see you back periodically.

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Acute Zonal Occult Outer Retinopathy299 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy257 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy206 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy238 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy156 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy165 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy254 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy142 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy137 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy203 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy176 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy182 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy165 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy118 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy97 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy88 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy89 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy135 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy128 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy119 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy159 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy148 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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Acute Zonal Occult Outer Retinopathy232 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.

VISUAL ACUITY: OD: 20/20; OS: 20/40.
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45-year-old man was seen in the office on 1-29-08. He had muscle surgery when he was a child for strabismus. He does not, to his knowledge, have any problem with amblyopia. He noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay. VISUAL ACUITY: OD: 20/20; OS: 20/40. IOP: OS: 16, OS: 15. Color vision: 8/10 correct in each eye. Slit Lam Exam: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There is a nevus inferior to the fovea. OS: Vertical C/D ratio is 0.1. There is 1+ vitreous cells. The optic nerve is pink. There are peripheral bone spicules extending from 9:00 around to 6:00 sparing the macula. Photos confirm clinical findings. A fluorescein angiogram shows typical hyperfluorescence and window defects in the areas of the bone spicules, which are only present in the left eye and spare the macula, as you would expect in a patient with retinitis pigmentosa. IMPRESSION: 1. PERIPHERAL BONE SPICULES IN THE LEFT EYE. 2. POSSIBLY UNILATERAL RETINITIS PIGMENTOSA. 3. PROBABLE ACUTE ZONAL OCCULT OUTER RETINOPATHY. DISCUSSION: I explained to the patient that the signs in the left eye are consistent with retinitis pigmentosa, however this is typically a bilateral disease. There are reported cases in the literature of unilateral retinitis pigmentosa, but most of these pre-date the description of AZOOR, which has findings similar to that seen in retinitis pigmentosa. This patient’s eye is slightly different than most AZOOR eyes I have seen in that the patches of bone spicules in the left eye are in the periphery as you would expect in patients with retinitis pigmentosa. It is interesting, though, that the inferonasal quadrant is spared in the left eye. The only infectious disease I ordered blood tests for is syphilis, to rule that out. I asked him to return here for a check in three to four months, sooner should he notice any problem, and to see you back periodically.