title: Focal foveal atrophy of unknown etiology: clinical pictures and possible underlying causes.
abstract: OBJECTIVE
  Focal foveal atrophy is defined as the presence of a small, focal, ill-defined, hypopigmented foveal or juxtafoveal lesion, with the remaining retina unaffected. The purpose of this study was to report the clinical characteristics and optical coherence tomography (OCT) in patients with focal foveal atrophy of unknown etiology.
  
  
  METHODS
  The study was a retrospective observational case series. Data collected included complete ocular examination results for best corrected visual acuity (BCVA), ophthalmoscopy, fundus photography, fluorescein angiography, color sense discrimination tests, visual field tests, and OCT examinations.
  
  
  RESULTS
  Twenty-three eyes in 21 patients were examined. The mean patient age was 49.2 ± 15.4 years. The mean BCVA was 20/25. The 21 patients were divided into three groups according to OCT results. Group 1 eyes (n = 10) had intact inner and outer hyperreflective layers (HRLs), with the signal of the inner HRL corresponding to the junction between the inner and outer photoreceptor segments and the outer HRL corresponding to the retinal pigment epithelium (RPE). Group 2 eyes (n = 9) had small hyporeflective defects with defects in the inner HRL at the fovea but an intact outer HRL. Group 3 eyes (n = 4) had small hyporeflective defects in both the inner and outer HRLs at the fovea. Groups 3 eyes had significantly lower visual acuity compared to Group 1 eyes and Group 2 eyes. There was no significant difference in visual acuity between Group 1 and Group 2 eyes. There were no significant differences among the groups with respect to color vision or foveal thickness.
  
  
  CONCLUSIONS
  This is the first report of clinical presentations for patients with focal foveal atrophy of unknown etiology. OCT aided in the diagnosis and assessment of the degree of retinal structural abnormalities, but the real etiology of foveal atrophy remains unclear.
authors.affiliation: Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Tzu-Yun
authors.initials: TY
authors.lastname: Kao
authors.affiliation: Department of Ophthalmology, Cardinal Tein Hospital, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Muh-Shy
authors.initials: MS
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Jieh-Ren
authors.initials: JR
authors.lastname: Jou
authors.affiliation: Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chang-Ping
authors.initials: CP
authors.lastname: Lin
authors.affiliation: Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Tzu-Hsun
authors.initials: TH
authors.lastname: Tsai
authors.affiliation: Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: hotchang@ntu.edu.tw.
authors.forename: Tzyy-Chang
authors.initials: TC
authors.lastname: Ho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy / Q000175:diagnosis; D002648:Child; D055253:Color Vision; D005260:Female; D005451:Fluorescein Angiography; D005584:Fovea Centralis / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000175:diagnosis*; D012189:Retrospective Studies; D013624:Taiwan; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D055815:Young Adult
keywords: focal foveal atrophy; optical coherence tomography; visual function