Posterior Segment
Focal Choroidal Excavation
Also known as: focal choroidal excavation, FCE, choroidal excavation, conforming excavation, non-conforming excavation, pachychoroid spectrum
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Focal choroidal excavation is a localised dip in the choroid seen on OCT, in an eye with no posterior staphyloma and no scleral ectasia. It sits within the pachychoroid disease spectrum. Most patients have no symptoms or only mild blur or distortion, and the fundus may look normal. The main risk is macular neovascularisation. The optometry role is to recognise it on OCT, classify it, and review with OCT every 6 to 12 months.
Recognition
Symptoms: what patients report
- Usually none; often an incidental OCT finding.
- Mild blur or distortion in some patients.
- New or worsening distortion raises concern for macular neovascularisation.
Signs: what the examination shows
- Fundus may be normal or show only non-specific pigment change.
- OCT, conforming type: the outer retina follows the dip and the photoreceptor tips stay in contact with the RPE.
- OCT, non-conforming type: the photoreceptor tips are separated from the RPE, leaving a dark space.
- Fundus autofluorescence: irregular reduced signal over the affected area.
- No staphyloma or scleral ectasia.
What OptoGuide™ covers for focal choroidal excavation
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting