Related to this topic: Patient+ | Weblinks | Equipment | Books | Your Experience | Other resources | Glossaries
Print options: Printer friendly version of this leaflet (html)     Other options:  AddThis Social Bookmark Button (what's this?)

PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.

Forster-Fuchs' Retinal Spot

Synonyms: Fuchs' retinal spot, disciform degeneration in myopia, and choroidal neovascularization in myopia.

Description

Forster described subretinal neovascularisation in severely myopic eyes in 1862 and Fuchs described a pigmented lesion at or near the fovea in 1901. They are both part of the same process.

Epidemiology

Up to one third of severely myopic eyes can be affected.1 It can strike at any age but it is a very significant cause of blindness in young people in developed countries. A study in Australia found the spots in 3 of 3654 elderly people, giving a prevalence of 0.1% in this age group.2

Risk Factor

This is a condition seen in high myopia.

Presentation

Symptoms

  • Presentation is with deteriorating vision.
  • There may also be complaints of visual distortion with wavy lines or an object that is being viewed has part missing.

Signs

  • Ability to read the Snellen chart may deteriorate by 2 lines or more in a fairly short space of time.
  • The Forster-Fuchs spot may be seen near the fovea but there are wide variations in the appearance.
Differential Diagnosis
Investigations

Fluorescein angiography shows subretinal neovascularization from the choroid as the basic underlying disease in most cases.3

Management

Drugs

There is currently no pharmacological treatment.

Surgical

Conventional treatments of laser photocoagulation or surgical extraction of the area of neovascularisation have had limited effectiveness. Newly developed treatments such as foveal translocation or photodynamic therapy have had favourable results in the short-term.4 More RCTs are needed.

Surgical excision of subfoveal choroidal neovascular membranes in high myopia in a study brought improvement of visual acuity of at least 2 lines in 45% and no change in 37%.5 Presumably there was deterioration in 18%. Another trial had similar results6 with the visual acuity improved by 2 or more Snellen lines in 39%, decreased in 35% and remained unchanged in 26%.

Complications

Without treatment atrophy occurs around the area and prognosis is very poor.4 The new vessels cause traction on the retina.
N.B. Phototherapy should not be used near the fovea as this is an avascular area.

Prognosis

A study from Moorfields in 19837 showed a generally poor prognosis without intervention with 43% of the patients losing 2 or more lines of vision, while 60% were less than or equal to 6/60 at last follow-up. There was a direct relationship between visual acuity and the distance of the neovascular tissue from the fovea, and an inverse relationship between acuity and the size of the lesion. There seems to be a short neovascular growth phase, with early visual loss.

Older patients tend to have a poorer outcome than younger ones.8

Prevention

Optical coherence tomography1 can detect this at its early stages so that intervention may take place.


Document References
  1. Panozzo G, Mercanti A; Optical coherence tomography findings in myopic traction maculopathy. Arch Ophthalmol. 2004 Oct;122(10):1455-60. [abstract]
  2. Vongphanit J, Mitchell P, Wang JJ; Prevalence and progression of myopic retinopathy in an older population. Ophthalmology. 2002 Apr;109(4):704-11. [abstract]
  3. Levy JH, Pollock HM, Curtin BJ; The Fuchs' spot: an ophthalmoscopic and fluorescein angiographic study. Ann Ophthalmol. 1977 Nov;9(11):1433-43. [abstract]
  4. Ohno-Matsui K, Yoshida T; Myopic choroidal neovascularization: natural course and treatment. Curr Opin Ophthalmol. 2004 Jun;15(3):197-202. [abstract]
  5. Bottoni F, Perego E, Airaghi P, et al; Surgical removal of subfoveal choroidal neovascular membranes in high myopia. Graefes Arch Clin Exp Ophthalmol. 1999 Jul;237(7):573-82. [abstract]
  6. Uemura A, Thomas MA; Subretinal surgery for choroidal neovascularization in patients with high myopia. Arch Ophthalmol. 2000 Mar;118(3):344-50. [abstract]
  7. Hampton GR, Kohen D, Bird AC; Visual prognosis of disciform degeneration in myopia. Ophthalmology. 1983 Aug;90(8):923-6. [abstract]
  8. Tabandeh H, Flynn HW Jr, Scott IU, et al; Visual acuity outcomes of patients 50 years of age and older with high myopia and untreated choroidal neovascularization. Ophthalmology. 1999 Nov;106(11):2063-7. [abstract]

Internet and Further Reading
  • Picture; of Foster Fuchs retinal spot
  • RNIB; Royal National Institute for the Blind; Home page
Acknowledgements EMIS is grateful to the Mentor authoring team for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 2166
Document Version: 21
DocRef: bgp2185
Last Updated: 31 Jan 2007
Review Date: 30 Jan 2009


















Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.

Advertise on this site










Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.

Advertise on this site


PS - Health and Poverty

Perhaps the biggest cause of ill health in the world is poverty. Help to Make Poverty History. For example, why not lend some of your money to disadvantaged communities to enable them to trade their way out of poverty through schemes such as Shared Interest.

See also MAKEPOVERTYHISTORY North East for details and links to campaigns against poverty.

^ Top of Page