The authors present three cases of multiple evanescent white dot syndrome (MEWDS) with characteristic fundus autofluorescence (FAF) findings, including one patient without any visible white dots on funduscopic examination and another with many more hyperautofluorescent lesions than seen ophthalmoscopically. Additionally, the findings support an alternative mechanism for the hyperautofluorescent lesions in MEWDS, whereby photoreceptor loss causes unmasking of normal underlying retinal pigment epithelium autofluorescence. This hypothesis is demonstrated in two cases by optical coherence tomography showing clear ellipsoid zone attenuation with registration to hyperautofluorescent lesions. It is further supported in two cases by photoreceptor bleaching in successive FAF images captured in the same session leading to diminished autofluorescence intensity of the characteristic dots.
[Ophthalmic Surg Lasers Imaging Retina. 2013;44:588–592.]
From Jules Stein Eye Institute, UCLA, Los Angeles, California (AJ, ER, DS); Vitreous Retina Macula Consultants of New York, New York (KBF, JAS); Department of Ophthalmology, New York University School of Medicine, New York, New York (KBF, JAS); and Greater Los Angeles VA Healthcare Center, Los Angeles, California (DS).
Supported by the Macula Foundation, New York, NY.
The authors have no relevant financial or proprietary interest in the materials presented herein.
Address correspondence to David Sarraf, MD, Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, UCLA, 100 Stein Plaza, Los Angeles, CA 90095; 310-794-9921; fax: 310-206-7826; email:
Received: April 04, 2013
Accepted: September 20, 2013