A 21-year-old female presented for a routine exam with complaints of difficulty seeing while driving at night. Past ocular, medical and social history were unremarkable with the exception of oral contraceptive use. Family ocular history was notable only for senile macular degeneration in a maternal grandmother and moderate refractive errors in several family members.

Uncorrected visual acuity was 6/6 in both the right and left eyes. Refraction was -0.50 OU and color plate testing was normal in both eyes as were intraocular pressures. Anterior segments were unremarkable by slit-lamp examination. Posterior segments were as found in these photos:


  1. the diagnosis is absolutely incorrect- the night driving abnormality is due to the bilateral retinal infiltration with what appears to be granulomatous retinitis- active OD, inactive OS.

    1. Thank you for your emphatic diagnosis Dr Sinclair. I believe what you are interpreting as granulomatous retinitis is in fact photographic artifact. Visual acuity is 6/6 (20/20) uncorrected in each eye. Patient was found to have a refractive error of -0.50 D and the optic nerve head pit was merely an incidental finding.

      1. OK- thanks, but the small granulomas OD and scars OS do not look to be artifacts. Remember that visual acuity does not measure functional vision. Although it has been used for more than 180 years (oldest diagnostic tool in medicine in constant use, older than stethoscope), it has never been validated and does not measure vision. You can see my lecture a couple of weeks ago (at Microsoft). https://www.dropbox.com/s/oxi2mn2d46cnm07/%20VIP-%20to%20Assess%20and%20Assist-%20Sinclair%20Lecture%204.18.2019.pptx?dl=0

      2. I don’t disagree with you… however this case just so happens to be one of my daughters and I am her examining ophthalmologist for the past 21 years. I have an unfair advantage in this situation and the retina is normal.

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