There are a few things that a clinician will see in practice on a day to day basis that will give you a shock, then once you get your thoughts together you realize there isn’t much you can do except to refer out for observation. That was no exception this week.
A patient was scheduled for just a routine eye exam (26-year-old African American female). No vision issues noticed. Just a young lady who wanted to update her contact lens prescription. There were no notations on her paperwork that she had ever been diagnosed with any eye condition in the past, so when I took her Optomap photos I was surprised to see what I first thought was a very large nevus. Upon further investigation, I found that it was a CHRPE.
Congenital Hypertrophy of the Retinal Pigment Epithelium or CHRPE is a spot on the retina, or back of the eye, that is normally black in color and benign. The pigmented layer of the retina is the retinal pigment epithelium (RPE). It is the cell layer just outside the neurosensory retina that nourishes retinal visual cells. It is a very thin layer found between the photoreceptor layer of the retina and Bruch’s membrane and the choroid. When a person is born, they can have hypertrophic spots of RPE cells. These cells are called a CHRPE.
After seeing my fair share of retinal tumors, these spots can be alarming, however, the risk of the spots becoming cancerous is very low. They are common, and a patient may have just one lesion. There is the possibility of Familial Adenomatous Polyposis. This is an inherited condition in which adenomatous polyps form mainly in the epithelium and in the large intestine. While these polyps start out benign in the large intestine, these lesions can become malignant and turn into colon cancer if not diagnosed and treated early. Most patients with this syndrome will have multiple lesions. If this is the case, the patient will need to be referred to a gastrointestinal specialist.
Later in the week, a young lady (36-year-old African American female) wanted to make sure that our clinic had the correct machines to measure a patient with a -25.00 prescription. That’s not something you see every day, or even in years of practice. After digging further into her history, I found that she truly was extremely nearsighted and had refractive lens exchange surgery to help with correction. Due to the great degree of nearsightedness, she has a condition called myopic degeneration. This is a condition in which stretching of the eye damages the retina. The surgery was very successful and only left minus 0.50 spherical power with a slight astigmatism prescription for her eyewear in both eyes. However, her left eye is extremely esotropic which caused severe diplopia. This patient wanted a pair of glasses to correct her double vision. Unfortunately, she would need too many diopters of prism to make this possible. This patient was referred to a retinal specialist to evaluate that thin retina, and to a pediatric ophthalmologist for muscle surgery. We hope to see her back after surgery to monitor her eye health closely.
Optomap showing CHRPE to the right of the optic nerve disc
Never a dull day! No matter how many years you work in a clinic, you will always see new and interesting things. Always keep yourself educated and research the diagnosis that you are not familiar with to ensure that the next time you see something similar, you are prepared to help your doctors educate and care for your patients.
Optomap showing myopic degeneration
Learn more about the importance of understanding and controlling myopia in our CE, Controlling Myopia in Children at www.2020mag.com/ce.