subretinal fluid accumulation, hemorrhage, lipid exudation, and fibrosis (in the late stages).

CLINICAL SIGNS AND SYMPTOMS

MYOPIA

Typical fundus changes in high myopia include tilted discs, peripapillary atrophy, macular chorioretinal or RPE atrophy, and posterior staphyloma. Lacquer cracks are caused by spontaneous ruptures in Bruch’s membrane and are commonly associated with small hemorrhages. The RPE overlying these hemorrhages atrophies, leaving a linear or stellate pattern of RPE loss. Fuchs’ spots are submacular slightly raised and pigmented circular lesions which consist of an ingrowth of fibrovascular tissue. CNV is usually seen as a small light-gray round or elliptical macular lesion. Progressive atrophic changes in the macula often cause gradual visual loss by the fifth decade. The development of CNV causes visual loss at a younger age and induces a sudden painless reduction in vision, usually associated with metamorphopsia.20

PRESUMED OCULAR HISTOPLASMOSIS SYNDROME

Patients with POHS can be asymptomatic or present with an acute or insidious progressive blurring of central vision and metamorphopsia.9 Fundus examination reveals multiple “punched-out” atrophic choroidal scars, peripapillary atrophy, and macular CNV or fibrovascular disciform scar, without anterior chamber or vitreous inflammation.8,9,12

ANGIOID STREAKS

Patients with angioid streaks are usually asymptomatic unless the macula is involved or CNV is present, leading to decreased vision or symptoms of metamorphopsia. Fundus examination reveals irregular linear dark red or brown bands radiating from the optic disc. A peculiar mottling of the RPE described as “peau d’orange” is commonly seen in the temporal midperiphery in patients with PXE, but has also been observed in patients with angioid streaks who do not have PXE.15