Benign fleck retinal findings on multifocal ERG, microperimetry, and OCT

Abstract

A middle-aged asymptomatic woman presented with multiple yellow-white flecks in the retinal pigment epithelium (RPE) affecting both fundi in a symmetrical pattern. The lesions were distributed around the posterior pole and midperiphery but sparing the macula, a picture similar to what was defined by Gass as benign fleck retina. Visual acuity, visual fields, full-field electroretinogram, electrooculogram, and dark adaptation were normal. Multifocal electroretinogram [0] (mfERG) was slightly subnormal in the isopters 17° to 20°. In this same area, microperimetry confirmed a mild decrease in sensitivity more patent in the upper temporal sector where some hypoautofluorescent spots were detected. Optical coherence tomography (OCT) obtained through the flecks revealed a small increase in the thickness of the RPE. Autofluorescence showed increased autofluorescence within the flecks. OCT confirmed the anatomical location of the defect, whereas mfERG and microperimetry demonstrated for the first time that benign fleck retina can entail a functional defect.