Eagleview Eye Clinic

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FUCH’S SPOT

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

  1. High myopia stretches the eye: Eyeball gets too long, >26.5 mm
  2. Bruch’s membrane cracks: Lacquer cracks develop from the stretching
  3. CNV grows: New, fragile blood vessels from the choroid grow through the cracks
  4. Bleeding occurs: Those vessels leak or burst, causing subretinal hemorrhage under the macula
  5. 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.

ICG ANGIOGRAPHY

ICG angiography = Indocyanine Green Angiography. It’s an imaging test that maps blood flow in the choroid, the blood-vessel layer under your retina.

What it is

  • Dye test: A green dye called indocyanine green is injected into your arm vein
  • Infrared camera: Special camera uses near-infrared light at 790-805 nm to see the dye through the retinal pigment
  • Shows choroid: Unlike fluorescein angiography which shows retinal vessels, ICG goes deeper and highlights choroidal circulation

Why doctors order it

  • See through blood/pigment: ICG light penetrates melanin, fluid, and thin blood. Useful when fluorescein images are blocked
  • Diagnose specific conditions:
    • Choroidal neovascularization (CNV): Especially “occult” CNV hidden under the retina in AMD
    • Polypoidal choroidal vasculopathy (PCV): Branching vessels with polyp-like aneurysms, common in African/Asian patients
    • Central serous chorioretinopathy (CSCR): Shows choroidal hyperpermeability areas
    • Lacquer cracks: Checks if CNV is growing through the cracks
    • Inflammatory diseases: Vogt-Koyanagi-Harada, choroiditis, to see active lesions
    • Tumors: Choroidal melanoma vs nevus

How the test works

  • Prep: Pupils dilated. You’ll sign consent and get an IV line
  • Injection: 25 mg ICG dye injected into arm. It binds to plasma proteins and stays inside blood vessels
  • Imaging phases:
    • Early 0-1 min: Choroidal arteries and choriocapillaris fill
    • Mid 5-15 min: Venous phase and leakage patterns show
    • Late 20-30 min: Staining or “washout” patterns. Polyps stay bright late
  • Time: Takes 20-30 minutes total

ICG vs Fluorescein angiography
Feature ICG Fluorescein
Light used Near-infrared 790-805 nm Blue light 490 nm
What it shows Choroidal vessels Retinal vessels
Dye leakage Minimal. Stays in vessels Leaks easily from damaged vessels
See through blood Yes No
Best for PCV, CSCR, occult CNV, choroidal tumors Diabetic retinopathy, vein occlusion, macular edema
Safety & side effects

  • Very safe: Severe reaction rate is about 0.05%, much lower than fluorescein
  • Common effects: Temporary green discoloration of skin, green urine for 1 day
  • Mild reactions: Nausea in 1-2%, sneezing, itching
  • Contraindications: Iodine allergy because ICG contains iodine. Also avoid in liver disease and pregnancy unless essential
  • No kidney issues: Unlike CT contrast, ICG isn’t nephrotoxic

What to expect after

  • Vision: Not blurred by the dye itself, but dilation makes you light sensitive for 4-6 hours
  • Drive: Bring someone. You can’t drive until dilation wears off
  • Results: Retina specialist reads images same day and decides on treatment like anti-VEGF or photodynamic therapy

Bottom line: If fluorescein angiography shows the retinal circulation, ICG shows the “basement” blood supply under it. It’s the go-to test when doctors suspect PCV, CSCR, or hidden CNV, especially in highly pigmented eyes.

ICG ANGIOGRAPHY

ICG angiography = Indocyanine Green Angiography. It’s an imaging test that maps blood flow in the choroid, the blood-vessel layer under your retina.

What it is

  • Dye test: A green dye called indocyanine green is injected into your arm vein
  • Infrared camera: Special camera uses near-infrared light at 790-805 nm to see the dye through the retinal pigment
  • Shows choroid: Unlike fluorescein angiography which shows retinal vessels, ICG goes deeper and highlights choroidal circulation

Why doctors order it

  • See through blood/pigment: ICG light penetrates melanin, fluid, and thin blood. Useful when fluorescein images are blocked
  • Diagnose specific conditions:
    • Choroidal neovascularization (CNV): Especially “occult” CNV hidden under the retina in AMD
    • Polypoidal choroidal vasculopathy (PCV): Branching vessels with polyp-like aneurysms, common in African/Asian patients
    • Central serous chorioretinopathy (CSCR): Shows choroidal hyperpermeability areas
    • Lacquer cracks: Checks if CNV is growing through the cracks
    • Inflammatory diseases: Vogt-Koyanagi-Harada, choroiditis, to see active lesions
    • Tumors: Choroidal melanoma vs nevus

How the test works

  • Prep: Pupils dilated. You’ll sign consent and get an IV line
  • Injection: 25 mg ICG dye injected into arm. It binds to plasma proteins and stays inside blood vessels
  • Imaging phases:
    • Early 0-1 min: Choroidal arteries and choriocapillaris fill
    • Mid 5-15 min: Venous phase and leakage patterns show
    • Late 20-30 min: Staining or “washout” patterns. Polyps stay bright late
  • Time: Takes 20-30 minutes total

ICG vs Fluorescein angiography
Feature ICG Fluorescein
Light used Near-infrared 790-805 nm Blue light 490 nm
What it shows Choroidal vessels Retinal vessels
Dye leakage Minimal. Stays in vessels Leaks easily from damaged vessels
See through blood Yes No
Best for PCV, CSCR, occult CNV, choroidal tumors Diabetic retinopathy, vein occlusion, macular edema
Safety & side effects

  • Very safe: Severe reaction rate is about 0.05%, much lower than fluorescein
  • Common effects: Temporary green discoloration of skin, green urine for 1 day
  • Mild reactions: Nausea in 1-2%, sneezing, itching
  • Contraindications: Iodine allergy because ICG contains iodine. Also avoid in liver disease and pregnancy unless essential
  • No kidney issues: Unlike CT contrast, ICG isn’t nephrotoxic

What to expect after

  • Vision: Not blurred by the dye itself, but dilation makes you light sensitive for 4-6 hours
  • Drive: Bring someone. You can’t drive until dilation wears off
  • Results: Retina specialist reads images same day and decides on treatment like anti-VEGF or photodynamic therapy

Bottom line: If fluorescein angiography shows the retinal circulation, ICG shows the “basement” blood supply under it. It’s the go-to test when doctors suspect PCV, CSCR, or hidden CNV, especially in highly pigmented eyes.

LACQUER CRACKS

Lacquer cracks are breaks in Bruch’s membrane, a thin layer in the back of your eye. They’re mostly linked to high myopia but can show up in other conditions too.

What exactly breaks?

  • Location: Bruch’s membrane sits between the retinal pigment epithelium (RPE) and the choroid. It’s like the “basement membrane” for the retina
  • The crack: Think of paint on a wall. If the wall stretches too much, the paint develops hairline cracks. Same idea when the eyeball elongates in high myopia
  • Appearance: On eye exams, they look like yellowish, irregular lines in the back of the eye, often near the macula

Main causes

  • Pathologic myopia: Biggest cause. Eyes longer than 26.5 mm or stronger than -6.00D stretch Bruch’s membrane until it tears
  • Trauma: Blunt injury to the eye can cause acute cracks
  • Angioid streaks: Associated with systemic diseases like pseudoxanthoma elasticum, Ehlers-Danlos, Paget’s disease. Angioid streaks can develop lacquer cracks
  • Choroidal neovascularization: Sometimes new blood vessels form around the cracks

Symptoms

  • Often none early: Many people have lacquer cracks with no vision change
  • If macula involved: Blurred vision, distorted vision where straight lines look wavy, or a blind spot
  • Sudden vision drop: Usually means a complication like bleeding or CNV has started

Complications to watch for

  • Choroidal neovascularization (CNV): New, leaky blood vessels grow through the crack. This is the main threat to vision and can cause bleeding/scarring
  • Subretinal hemorrhage: Blood under the retina from CNV, causes sudden central vision loss
  • Fuchs’ spot: Pigmented scar that forms after a bleed heals. Leaves permanent central scotoma

How doctors diagnose

  • Dilated fundus exam: Doctor sees yellow lines
  • OCT scan: Shows the break in Bruch’s membrane and any fluid/blood
  • Fluorescein angiography: Dye test to check for CNV leaking through the crack
  • ICG angiography: Better for seeing deeper choroidal vessels

Treatment

  • No fix for the crack itself: Bruch’s membrane can’t be stitched back. Goal is to manage complications
  • If CNV develops: Anti-VEGF injections like Avastin, Lucentis, or Eylea into the eye to stop new vessels
  • Monitor: Regular OCT scans if you have lacquer cracks, especially with high myopia
  • Lifestyle: No proven way to prevent them, but controlling myopia progression in kids may help reduce future risk

Who’s at risk

  • High myopes: -6.00D or worse, or axial length >26.5 mm
  • Age: Usually appears in 20s-40s in myopic patients
  • Family history: Pathologic myopia runs in families

Bottom line: Lacquer cracks themselves don’t always hurt vision. The danger is when new blood vessels grow through them. If you have high myopia, get yearly dilated eye exams so any CNV gets caught early.

STERILE BURR

A sterile burr is a small, drill-like ophthalmic instrument used to remove rust rings or embedded foreign bodies from the cornea. It’s typically single-use, precision-engineered, and comes pre-sterilized to prevent infection.

Here’s the step-by-step usage:

  1. Numb the eye with topical anesthetic drops.
  2. Position the patient comfortably under a slit lamp for magnification.
  3. Stabilize the eye using a lid speculum or gentle pressure.
  4. Activate the burr (usually battery-powered) and gently apply it to the rust ring or foreign body.
  5. Rotate lightly to scrape away the material without pressing too deep.
  6. Irrigate the eye to flush out debris.
  7. Apply antibiotic ointment and possibly a patch for comfort.
  8. Advise on aftercare — typically antibiotic drops, no rubbing, and follow-up if pain or vision changes persist.
CORNEA FOREIGN BODY REMOVAL

Corneal foreign body removal is a common eye procedure done when something like dust, metal, or sand gets stuck on the cornea. Here’s how it’s typically done:

  • Assessment: Doctor checks eye with a slit lamp to locate and evaluate the foreign body.
  • Anesthetic drops: Numbing eye drops are applied for comfort.
  • Removal: Using a sterile needle, burr, or cotton swab, the doctor gently lifts out the foreign object.
  • Post-care: Antibiotic eye drops or ointment are prescribed to prevent infection.
  • Follow-up: Healing usually happens within 24-48 hours; pain and redness should improve quickly.

CORNEA FOREIGN BODY

Corneal foreign body: small object (metal, dust, sand) stuck on eye surface. Causes pain, redness, tearing, blurry vision, and gritty feeling. Doctor removes it with slit lamp and tiny needle or swab. After removal, antibiotic drops prevent infection, and eye heals fast—usually 24–48 hrs.

OCULAR FITNESS REPORT

An ocular fitness report checks if your eyes meet health and vision standards for work, school, or driving. It includes:

  • Name, age, gender, ID
  • Visual acuity (distance/near, with/without glasses)
  • Refraction (need for glasses/contact lenses)
  • Color vision (Ishihara test or similar)
  • Eye health exam (check for infections, cataract, glaucoma, retinal issues)
  • Conclusion: “Fit,” “Fit with corrective lenses,” or “Not fit” with reason.
PATTERN ERG

Pattern ERG (PERG) measures electrical activity from retinal ganglion cells in response to a reversing checkerboard pattern. It’s great for spotting optic nerve issues like glaucoma and macular problems.

  • How it’s done: Electrodes on the eye, patient looks at a screen with a checkerboard pattern that flips contrast.
  • What it records: P50 wave (early positive) reflects ganglion cell function; N95 wave (negative) relates to optic nerve health.
  • Key use: Detects ganglion cell loss early, even before visual field defects show up.
  • Difference from full-field ERG: PERG focuses on central retina and optic nerve, not whole retinal response.
FULL ERG

Full-field ERG tests the entire retina’s electrical response to light. You get electrodes on the cornea or skin, dark-adapt for ~20 mins, then flashes of light stimulate rods and cones. It records a-waves (photoreceptor activity) and b-waves (inner retinal response). Used to diagnose widespread retinal diseases like retinitis pigmentosa or Leber congenital amaurosis. Results show overall retinal function, not localized areas.