Case Report: Unraveling Pigmented Paravenous Retinochoroidal Atrophy: The Utility of Multimodal Imaging in Diagnosis

Introduction Pigmented paravenous retinochoroidal atrophy is a rare retinal disorder of unknown etiology, characterized by retinal pigment epithelium degeneration, choriocapillaris and choroidal atrophy, and spiculated pigmentation along the retinal veins. Pigmented paravenous retinochoroidal atrophy is typically bilateral and often diagnosed incidentally in asymptomatic patients. Case Report A 20-year-old Hispanic individual presented with complaints of mild blur. Ocular history was notable for spectacle wear and an unknown retinal finding. Her systemic health history was unremarkable and family history was void of retinal disease. Best corrected visual acuity was 20/20 in each eye. Dilated fundus evaluation revealed spiculated pigmentary changes along the retinal veins with variable chorioretinal atrophy extending from the disc up to the equatorial retina in both eyes. A multimodal imaging and diagnostic protocol was implemented to document, diagnose, and monitor disease progression. Conclusion This case highlights a comprehensive diagnostic approach for pigmented paravenous retinochoroidal atrophy, emphasizing the role of multimodal imaging. Fundus photography, automated visual field testing, fundus autofluorescence, optical coherence tomography, optical coherence tomography–angiography, and electroretinography were used to characterize the condition. Additionally, laboratory and genetic testing were conducted to aid in differential diagnosis. This report underscores the importance of advanced imaging techniques in distinguishing, diagnosing, and managing rare retinal disorders.