Multimodal imaging of white and dark without pressure fundus lesions

Amani A. Fawzi, Jared S. Nielsen, Aranzazu Mateo-Montoya, Thanapong Somkijrungroj, Helen K. Li, John Gonzales, Martine Mauget-Faÿsse, Lee M. Jampol*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Purpose: To describe multimodal imaging findings in patients with dark or white without pressure lesions of the fundus.

Methods: Retrospective observational case series of 10 patients with white or dark without pressure lesions. We analyzed multimodal imaging using spectral domain optical coherence tomography, color and near-infrared fundus photography, and fundus autofluorescence imaging to explore the findings associated with these lesions.

Results: All patients had geographic dark or white lesions on clinical examination and color photography, which were either hyporeflective or hyperreflective on near-infrared reflectance imaging, respectively. On optical coherence tomography, these lesions correlated with an abrupt change of the photoreceptor reflectivity, with relative hyporeflectivity of photoreceptor zones (ellipsoid and interdigitation zones, as well as outer segments) within the dark, and relative hyperreflectivity within white lesions. Ten patients underwent fundus autofluorescence, which showed well-defined zones of relative hypoautofluorescence within the lesion, compared with neighboring uninvolved regions, whether dark or white without pressure. In two patients who had a lesion combining white and dark without pressure, we observed the transition in photoreceptor reflectivity from the dark lesion (hyporeflective) to the white lesion (hyperreflective), relative to the surrounding retina.

Conclusion: Both white and dark without pressure lesions are associated with changes in outer retinal reflectivity on optical coherence tomography, which occur in opposite directions compared with the surrounding unaffected areas. In the face of normal visual field testing to date, the clinical significance of this finding remains uncertain. Recognition of the optical coherence tomography appearance will help clinicians avoid unnecessary workup of these patients for outer retinal dystrophy or degeneration.

Original languageEnglish (US)
Pages (from-to)2376-2387
Number of pages12
Issue number12
StatePublished - Dec 11 2014


  • Dark without pressure
  • Fundus autofluorescence
  • Optical coherence tomography
  • White without pressure

ASJC Scopus subject areas

  • Ophthalmology

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