Research

Presumed Unilateral Double Fovea in a Child

AAO Journal5d ago1 min read

An 8-year-old boy was found to have a right macular abnormality during routine screening. Best-corrected visual acuity was 20/20. Fundus photography showed 2 foveal reflexes (A). OCT angiography revealed an additional area of reduced capillary density temporal to the foveal avascular zone (B). Three-dimensional OCT reconstruction and the corresponding B-scan (C, bottom) showed an accessory depression adjacent to the primary fovea. Microperimetry showed fixation at the primary fovea, with measurable sensitivity near the temporal accessory depression (D).

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AI Summary

Quick Take

A routine screening of an 8-year-old boy revealed a rare unilateral double fovea in the right eye, characterized by two distinct foveal reflexes and an accessory macular depression. Despite this structural anomaly, the patient maintained 20/20 best-corrected visual acuity, with microperimetry confirming functional sensitivity at the accessory site.

Why It Matters

This case underscores the utility of multimodal imaging in identifying rare congenital macular variations that can mimic more serious pathologies. While a double fovea is an anatomical rarity, the fact that the accessory depression showed measurable sensitivity on microperimetry provides insight into the plasticity of foveogenesis. For clinicians, recognizing these benign developmental anomalies is essential to avoid unnecessary interventions and to provide accurate prognostic counseling for pediatric patients who present with atypical fundus appearances.

Key Findings

Fundus photography of the right eye identified two distinct foveal reflexes in an asymptomatic 8-year-old child.
Optical coherence tomography angiography (OCTA) revealed a secondary area of reduced capillary density located temporal to the primary foveal avascular zone.
3D OCT reconstruction and B-scans confirmed the presence of an accessory anatomical depression adjacent to the primary fovea.
Microperimetry demonstrated that the patient fixates using the primary fovea, but the accessory temporal depression retains measurable retinal sensitivity.
The patient's best-corrected visual acuity remained 20/20, indicating that the duplication did not negatively impact central vision development.

Practice Implications

When encountering unusual macular reflexes during pediatric exams, clinicians should employ OCT and OCTA to differentiate between benign structural duplications and potentially vision-threatening lesions. Microperimetry can be a useful adjunct to determine if accessory structures are functional and to monitor fixation stability over time.

Who's Affected

Pediatric OptometristsPediatric OphthalmologistsRetina Specialists

Evidence StrengthPreliminary

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