Case Presentation

A 39-year-old female with multiple sclerosis (MS) was referred for incidental findings on an outside optometry exam. The patient’s visual acuity was 20/50 OD and 20/40 OS, partially due to posterior subcapsular cataracts (PSC). Further examination and optomap 200-degree, single-capture ultra-widefield (UWF) imaging led to the diagnosis of uveitis with bilateral vasoproliferative tumors (VPT) found on the inferior peripheral retina.

Uveitis is known to affect otherwise healthy individuals, but in patients with MS it can occur at a rate 10 times more common than that of the general population. The presence of VPT is also relatively rare, though MS is the leading known cause in non-idiopathic cases. These lesions are most frequently located in the inferotemporal segment, suggesting that not only is this disease uncommon, but potentially hard to find.

Image Findings

Our routine is to capture central 200° UWF on all clinic patients, but in cases like these, a steered image was critical for guiding treatment planning. The addition of UWF optomap natural color RGB to our clinic has enhanced visualization of peripheral lesion characteristics, as in this case, where we can discern inherent blood vessels versus neovascularization even in the presence of PSC. The lesions have remained stable, though complications of VPT can lead to vision loss, highlighting the importance of photodocumentation via OptosAdvance software at subsequent visits.

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