This 62-year-old man was referred to the medical retina clinic by his optician for investigation of ‘cystoid macular oedema’ following a routine sight test, which included a macular OCT scan.
The OCT scan of the left macula shows slit-like cystic spaces within the inner nuclear layer, inferior to the fovea.
The left optic disc appeared slight pale compared to the right.
This patient has a history of a left non-arteritic ischaemic optic neuropathy (AION) with some superior visual field loss. The OCT features are typical of microcystic macular oedema, which represents retrograde retinal changes secondary to optic nerve pathology, such as demyelinating optic neuritis, glaucoma, AION or compressive lesions, or conditions affecting the visual pathways.
When microcystic macular oedema is seen on OCT, a patient’s optic nerve function should be tested (VA, colour vision, pupil reactions, visual fields) and neuroimaging should be considered.