A 60-year-old presents with blurred vision. Why?

Tip #170


Here the macula is structurally within normal limits centrally. However, there are significant areas of hyperreflectivity which involve the inner nuclear, outer plexiform and outer nuclear layer. The patient was noted to have significant non-perfusion on angiography (see video) and a widened intercapillary distance (video).

While the patient had elements of IRVAN (idiopathic retinal vasculitis, aneurysms and neuroretinitis); they were diagnosed with adult-onset Coat's disease.

In this tip's accompanying 19 min. video, Dr. Sharma takes you through additional diagnostic imagery as well as:

  • Consider the differential diagnosis for middle layer hyperreflectivity
  • The blood test that may be abnormal in a patient with IRVAN
  • The angiogram features of Coats’ disease
Tip #170 Analysis


Hyperreflectivity that causes absolute shadowing in the middle retina is exudate until proven otherwise.

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