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Mattie Adams
This 67YO male was referred for asymptomatic pigmented lesions in his left eye. Vision was 20/30 in his normal OD and 20/25 OS. Fundus imaging shows bear-track lesions (grouped congenital hypertrophy of the RPE) scattered throughout the posterior pole. These lesions are hypo-autofluorescent on fundus autofluorescence (FAF).
Learning Points:
Group-type congenital pigmented nevi of the RPE (bear tracks) is a relatively rare congenital condition characterized by well-demarcated, hyperpigmented, flat, variably sized RPE lesions that resemble bear footprints. Histopathologically, these lesions resemble congenital hypertrophy of the RPE (CHRPE), with increased pigment granules in normal-sized RPE cells. They are benign and cause no visual symptoms.
The major fluorophore in fundus autofluorescence (FAF) is lipofuscin, which is intraliposomal RPE material generated as byproducts of outer segment metabolism. The outer retina overlying these bear track lesions shows varying degrees of atrophy. This leads to less lipofuscin production with hypo-FAF.
Although bear tracks and the typical CHRPE lesions (large, round, unilateral, with depigmented lacunae with age) are not associated with systemic abnormalities, the multifocal, often bilateral and small comet-shaped lesions with FAP are associated with colonic polyps and cancer (Romania et al, Ophthalmology 1992;99:911-913).
Acta Ophthalmol. 2026 Nov;104(7):e803-e809. doi: 10.1111/aos.70150.
nAMD Vision-related quality of life stable with unilateral disease, but decreased without recovery in 2nd eye — FASTBAT, 424 patients
Purpose: The study evaluated the long-term effect on vision-related quality-of-life (VRQoL) of routinely treated neovascular age-related macular degeneration (nAMD) in first and second eyes.
Methods: The FASBAT (Observing Fibrosis, macular Atrophy and Subretinal highly reflective material Before and After Treatment with anti-VEGF treatment) study followed individuals with new unilateral nAMD (first eye) undergoing routine treatment for up to 4.5 years. Visual acuity (VA) was measured as part of routine care and VRQoL was assessed using the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25).
Results: Of the 424 participants, 307 had only the first eye affected by nAMD (mean age = 76.5, SD = 8.4 years). The mean VA was 58.1 (SD = 15.5) and 79.4 (SD = 5.6) letters at baseline, and 58.4 (SD = 20.9)/78.5 (SD = 7.8) letters at 36-months in the affected and unaffected eyes, respectively. The mean composite NEI-VFQ-25 score was 87.1 (SD = 11.9) at baseline and 85.2 (SD = 13.5) at 36-months. One hundred and seventeen participants (mean age = 77.6, SD = 7.3 years) developed second eye nAMD, with a mean of 18.9 (SD = 10.2) months following the first eye. Mean VA in first and second eye was 56.3 (SD = 19.3)/74.1 (SD = 9.9) letters at the time of second eye development, and 51.1 (SD = 22.5)/73.6 (SD = 8.9) letters after 24-months. Mean composite NEI-VFQ-25 score was 81.4 (SD = 14.6) and 79.1 (SD = 17.2) at these time points.
Conclusions: Long-term VRQoL remains stable in unilateral treated nAMD. However, a clinically meaningful reduction in VRQoL occurs following development and treatment in the second eye which does not recover. It is important to offer appropriate support when the first and then second eye develop nAMD.
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