Baltimore Eye Doctor on Spots in Eyes

Baltimore Washington Eye Center, Maryland

Thursday, July 12, 2012

Baltimore Eye Doctor on Spots in Eyes

Baltimore Washington Eye Center eye doctor, Dr. Shari Strier shared a recent patient experience regarding “spots in the eye.” Dr. Strier relayed her experience and thoughts, ‘I was seeing a patient on follow up the other day. She had been asked to return for a six month dilated exam in order to monitor the pigmented lesion that had been noted on her retina at her initial visit with us. I examined her eye and assured her that the spot had not changed in appearance and continued to look benign. She told me that after her last visit she had read an article in the Washington Post and was surprised to learn that a spot on the retina could indicate an increased risk of colon cancer. She was fascinated by the fact that something in the eye could tell you about the risk of disease in such a distant part of the body.

When a patient is told they have a pigmented spot on the retina it usually falls into one of two categories: choroid nevus or hypertrophy of the retinal pigment epithelium. A choroidal nevus is an area of hyper pigmentation occurring in the melanocytes in the vascular layer beneath the retina known as the choroid. Because it is being seen through the filter of the retina and the normal retinal pigment a choroidal nevus appears as a slate gray lesion underlying other retinal structures. These lesions occur in about five to ten percent of the population. The concern in patients with choroidal nevus, just like in patients with hyper pigmented skin lesions or moles, is that the lesion may become malignant melanoma. The chances of a choroidal nevus transforming into melanoma is only 1 in 20,000. Any newly documented nevus will be monitored by your eye doctor by direct examination during a dilated eye exam, size and thickness measurements of the lesion with B-scan ultrasound and photo documentation to look carefully for change in appearance over time.

The other type of pigmented lesion seen is Congenital Hypertrophy of the Retinal Pigment Epithelium or CHRPE. This is an over production of pigment in the retinal pigment epithelium the layer of pigment cells that lies just below and helps to nourish the neuro-sensory or ‘seeing’ retina. CHRPE appears as a jet black lesion often surrounded by a halo of atropic retina. CHRPE can appear as a single large spot or as a cluster of smaller spots that resemble paw prints. This multifocal appearance is often referred to as bear tracking. When bear tracking is seen in an atypical shape and occurs in both eyes there is a strong correlation with Gardner’s syndrome a form of Familial colonic adenomatous polyposis (FAP). FAP is a genetic disorder associated with hundreds to thousands of polyps and early onset of colorectal cancers. CHRPE in only one eye occurs in 0.5%-1.0% of the population. Atypical bilateral (occurs in both eyes) multifocal (many spots) CHRPE occurs in about 1 in 100,000 patients and is the only pigmented lesion associated with FAP. If this presentation is noted during an exam a thorough history including any family members with a history of FAP should be taken. Base line thickness measurements will be done and a referral for a gastroenterologist screening and further genetic testing will be made.

I assured my patient that based on our clinical exam she had a classic choroidal nevus and that her pigmented retinal lesion did not indicate an increased risk of colon cancer.

Guest Blogger: Shari E. Strier, O.D. with the Baltimore Washington Eye Center
To learn more or to schedule an eye examination at Baltimore Washington Eye Center please feel free to call 800-495-3937, visit Baltimore Washington Eye Center or, so that we can help identify the possible causes of your eye problem and recommend an appropriate treatment plan.

Baltimore Washington Eye Center is a leading eye care practice serving the greater Baltimore and Washington, D.C. area staffed by a team of Ophthalmologists, Optometrists, Opticians, technical and administrative staff who provide eye examinations for adults and children, diagnosis and treatment of cataracts including cataract surgery and intraocular lens implants (IOL), laser vision correction such as LASIK, diagnosis and treatment of cornea disease, care for diseases of the retina including diabetes and age related macular degeneration (AMD) and diagnosis and treatment of glaucoma as well as contact lenses, eyeglasses, eyewear and optical services. Baltimore Washington Eye Center is conveniently located for patients from Arbutus, Carney, Clarksville, Columbia, Dundalk, Edgemere, Essex, Ellicott City, Ferndale, Glen Burnie, Kenwood, Laurel, Linthicum, Lutherville, Millersville, Odenton Owings Mills, Reisterstown, Towson, Parkville, Randallstown, Rivera Beach, Pasadena, Severna Park, South Gate and Woodlawn Maryland.