Posterior Segment
Pattern Dystrophy
Also known as: pattern dystrophy, pattern dystrophy of the RPE, adult-onset foveomacular vitelliform dystrophy, adult vitelliform, AOFVD, butterfly dystrophy, reticular dystrophy, fundus pulverulentus
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
Pattern dystrophies are a group of macular dystrophies with pigment or yellow deposits at the level of the RPE in both eyes. Onset is from the second to the fifth decade and most patients have no symptoms until their fifties. Acuity is usually good through middle age, but severe vision loss affects up to half of patients in later life. Subtypes are adult-onset foveomacular vitelliform dystrophy, multifocal pattern dystrophy resembling Stargardt disease, butterfly dystrophy, reticular dystrophy and fundus pulverulentus. The optometry role is to recognise the pattern, separate it from age-related macular degeneration, and watch for atrophy or neovascularisation.
Recognition
Symptoms: what patients report
- Usually none until the fifth decade.
- Mild central blur or distortion.
- Slow decline in reading vision in older age.
Signs: what the examination shows
- Adult-onset foveomacular vitelliform: a yellow subfoveal deposit about one third of a disc diameter in each eye, sometimes with a central pigment spot.
- Multifocal: irregular yellow flecks across the posterior pole, like those of Stargardt disease.
- Butterfly: three to five yellow-white or dark linear arms radiating from the fovea.
- Reticular: a fishnet of dark lines that fade to leave RPE atrophy. Fundus pulverulentus: fine dotted pigment clumping with depigmented patches.
- OCT: bright change at the photoreceptor and RPE interface. A vitelliform deposit is a dome of uniform subretinal material that later partly liquefies, flattens, then becomes atrophic.
- Fundus autofluorescence: deposits are bright; atrophy is dark; reticular and pulverulentus forms are mottled.
What OptoGuide™ covers for pattern dystrophy
- 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