Fuchs spot = Fuchs’ spot. It’s a pigmented scar in the macula caused by bleeding from choroidal neovascularization (CNV). Almost always seen in people with pathologic myopia.
What it is
- Location: Center of the macula, the part of your retina used for sharp central vision
- Appearance: Round or oval dark spot. Color ranges from gray-black to reddish-brown depending on how old it is
- Cause: End result of a subretinal bleed that healed. The blood gets replaced by scar tissue + pigment
How it forms
- High myopia stretches the eye: Eyeball gets too long, >26.5 mm
- Bruch’s membrane cracks: Lacquer cracks develop from the stretching
- CNV grows: New, fragile blood vessels from the choroid grow through the cracks
- Bleeding occurs: Those vessels leak or burst, causing subretinal hemorrhage under the macula
- Scar formation: As blood clears over weeks to months, fibrovascular tissue + RPE hyperpigmentation forms. That’s the Fuchs spot
Who gets it
- Pathologic myopia: Main group. Usually -6.00D or worse
- Age: Typically 30s to 50s, younger than regular AMD
- Other names: Sometimes called Forster-Fuchs’ spot. Not related to Fuchs’ endothelial dystrophy of the cornea
Symptoms
- Central vision loss: Blur or a dark/empty spot right in the middle of vision
- Distortion: Straight lines look bent or wavy before the scar fully forms
- Scotoma: Once scarred, you’ll have a permanent blind spot in the center
- Often unilateral first: Can happen in the other eye later if myopia is severe in both
Diagnosis
- Dilated fundus exam: Doctor sees a pigmented macular lesion
- OCT scan: Shows subretinal scar tissue and disrupted retinal layers
- Fluorescein/ICG angiography: Used early to find active CNV before it scars. Once it’s a Fuchs spot, the vessels are usually inactive
- History: Patient usually reports a prior episode of sudden central vision drop from the bleed
Treatment
- No reversal: A true Fuchs spot is a scar. Vision in that exact spot doesn’t come back
- Goal is prevention: Treat the CNV before it bleeds and scars
- Anti-VEGF injections: Avastin, Lucentis, Eylea injected into the eye if active CNV is caught
- Photodynamic therapy: Rarely used now, but was an option before anti-VEGF
- Low vision aids: If central vision is lost, magnifiers and rehab help with daily tasks
Prognosis
- Vision impact: Depends on size and location. A small spot off-center may leave 6/12 vision. One dead center can drop to 6/60 or worse
- Other eye risk: 30-35% chance of CNV in the second eye within 8 years if you have high myopia
- Stability: Once scarred, it usually doesn’t grow. But new CNV can form at the edge
Fuchs spot vs other macular scars
Condition Cause Age group
Fuchs spot Myopic CNV bleed 30s-50s, high myopes
Disciform scar AMD CNV 60+, non-myopes
Toxoplasmosis scar Infection Any age, often kids/young adults
Bottom line: Fuchs spot is the “tombstone” left after a myopic CNV bleed. The key is catching CNV early with regular OCT scans if you’re a high myope, because once the spot forms, central vision loss is permanent.