Outer Foveal Microdefects

Ophthalmol Retina. 2021 Jun;5(6):553-561. doi: 10.1016/j.oret.2020.09.018. Epub 2020 Sep 30.


Purpose: To report a spectral-domain (SD) OCT clinical sign, outer foveal microdefect (OFMD), corresponding to a focal disruption of the foveal photoreceptors in association with various macular conditions.

Design: Retrospective cohort study.

Participants: Forty-five patients with OFMD.

Methods: All patients were imaged with color photography and SD OCT, and some were imaged with autofluorescence imaging, fluorescein angiography, indocyanine green angiography, or a combination thereof. Patient demographics, OFMD imaging, courses, and outcomes were analyzed retrospectively.

Main outcome measures: Demographics, conditions associated with OFMD, and diameter of OFMD.

Results: Fifty-one eyes of 45 patients (15 men and 30 women; age range, 10-88 years) were included. Symptoms included central scotoma, metamorphopsia, and mild to moderate visual loss. Outer foveal microdefects were observed in association with various macular conditions: presumed posterior vitreous detachment, vitreomacular interface changes, or both (24 eyes); sequelae of macular edema (3 eyes); blunt trauma (2 eyes); retinal phototoxicity resulting from laser or solar maculopathy (5 eyes); and macular telangiectasia type 2 (2 eyes). An improvement with a reduction in OFMD diameter was documented in 9 of 14 eyes that could be followed up.

Conclusions: We suggest renaming the condition outer foveal microdefect instead of macular microhole, which is usually associated with a vitreomacular disorder. The pattern indeed also was observed in traumatic or degenerative conditions. We assumed that various injuries led to changes in foveal morphologic features and that a full recovery of the foveal architecture could be altered, especially in eyes with findings suggestive of the pachychoroid spectrum of disorders.

Keywords: Macular microhole; OCT; Outer foveal microdefect; Pachychoroid; Posterior vitreous detachment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Female
  • Fluorescein Angiography / methods*
  • Follow-Up Studies
  • Fovea Centralis / diagnostic imaging*
  • Fundus Oculi
  • Humans
  • Male
  • Middle Aged
  • Ophthalmoscopy
  • Retinal Perforations / diagnosis*
  • Retrospective Studies
  • Tomography, Optical Coherence / methods*
  • Young Adult