Purpose: To report a case of bilateral decrease in central vision with almost normal fundus examination.
Methods: A 50-year-old white man with central visual loss followed since 2006 with detailed ophthalmologic examinations and ancillary tests, including autoimmune and antiretinal antibody analyses.
Results: Virtually normal ophthalmoscopic examination, fluorescein and indocyanine green angiography, autofluorescence, red-free fundus pattern, and peripheral visual field testing. Abnormalities include reduced central macula thickness values (right and left eyes were 150 μm and 146 μm, respectively) on the spectral-domain optical coherent tomography (normal value, 200-250 μm) and decreased sensitivity of foveal eccentricities on multifocal electroretinogram. Antiretinal antibody tested positive for 27-kDa protein; and anti-optic nerve antibodies tested positive against 33-kDa, 35-kDa, and 46-kDa proteins.
Conclusion: A central visual deficit with a nearly normal clinical picture and no family history are indicative of poorly defined entity called occult maculopathy. The role of antiretinal antibodies is unclear.