Occult retinal and choroidal vascular disease. The value of timed and directed fluorescein angiography.

Abstract

Acute vascular disease of the choroid or large vessels of the retina is usually accompanied by funduscopic signs. In instances of monocular visual loss, such objective signs are important diagnostic clues that the pathology is in the eye and not in the optic nerve. Fluorescein angiography was timed in a consistent manner, and photographs were taken at two frames per second. Orientation of the camera was customized for each patient based on the location of the visual field defect. Eight patients with monocular visual loss were referred because the cause of the visual loss was not evident. In each patient, fluorescein angiography showed vascular disease of either the choroid or retina, despite normal-appearing fundi. Fluorescein angiography can detect otherwise occult vascular disease of the retina or choroid. In eyes with monocular scotomas, the angiogram should be performed with the camera oriented with respect to the location of the visual field defect. Accurately timed, rapid sequence photography provides additional information about rate and symmetry of flow. Focal areas of hypoperfusion often are incidental but deserve added consideration when they correspond to the location of a scotoma.