Key Points

Question What is the structural change seen with acute solar retinopathy on high-resolution in vivo en face imaging?

Findings In this case of a young adult woman who presented 3 days after viewing a solar eclipse with classic symptoms of solar retinopathy, adaptive optics scanning light ophthalmoscopy provided high-resolution images of foveal cone photoreceptor mosaic disturbance, and en face optical coherence tomography showed corresponding reflectivity changes. Optical coherence tomography angiography was normal in both eyes, and microperimetry showed an absolute central scotoma in the more affected eye.

Meaning Acute solar retinopathy can result in localized foveal cone photoreceptor injury and dysfunction.

Abstract

Importance Solar retinopathy is a rare form of retinal injury that occurs after direct sungazing.

Objective To enhance understanding of the structural changes that occur in solar retinopathy by obtaining high-resolution in vivo en face images.

Design, Setting, and Participant Case report of a young adult woman who presented to the New York Eye and Ear Infirmary with symptoms of acute solar retinopathy after viewing the solar eclipse on August 21, 2017.

Main Outcomes and Measures Results of comprehensive ophthalmic examination and images obtained by fundus photography, microperimetry, spectral-domain optical coherence tomography (OCT), adaptive optics scanning light ophthalmoscopy, OCT angiography, and en face OCT.

Results The patient was examined after viewing the solar eclipse. Visual acuity was 20/20 OD and 20/25 OS. The patient was left-eye dominant. Spectral-domain OCT images were consistent with mild and severe acute solar retinopathy in the right and left eye, respectively. Microperimetry was normal in the right eye but showed paracentral decreased retinal sensitivity in the left eye with a central absolute scotoma. Adaptive optics images of the right eye showed a small region of nonwaveguiding photoreceptors, while images of the left eye showed a large area of abnormal and nonwaveguiding photoreceptors. Optical coherence tomography angiography images were normal in both eyes. En face OCT images of the right eye showed a small circular hyperreflective area, with central hyporeflectivity in the outer retina of the right eye. The left eye showed a hyperreflective lesion that intensified in area from inner to middle retina and became mostly hyporeflective in the outer retina. The shape of the lesion on adaptive optics and en face OCT images of the left eye corresponded to the shape of the scotoma drawn by the patient on Amsler grid.

Conclusions and Relevance Acute solar retinopathy can present with foveal cone photoreceptor mosaic disturbances on adaptive optics scanning light ophthalmoscopy imaging. Corresponding reflectivity changes can be seen on en face OCT, especially in the middle and outer retina. Young adults may be especially vulnerable and need to be better informed of the risks of viewing the sun with inadequate protective eyewear.