A challenge in the management of white dot syndromes is the lack of sensitive objective measures of disease activity. visual loss when complicated by choroidal neovascularisation (CNV) and subretinal fibrosis . Stages in the evolution of PIC lesions on spectral domain optical coherence tomography (SD-OCT) have been described [3, 4]. Although blue wavelength fundus autofluorescence (FAF) can help discriminate between active and atrophic lesions, findings can sometimes be ambiguous . We describe the application of systematic retinal thickness map analysis of SD-OCT (Heidelberg Eye Explorer?, Heidelberg, Germany) as a useful adjunct in detecting lesion activity in PIC. Case example A 43-year-old Caucasian female was diagnosed with PIC after presenting with photopsia associated with active retinal lesions and multifocal chorioretinal atrophic lesions in the macula in her left eye. Her right 1320288-19-4 manufacture eye had long-standing macular scarring with vision of hand movements. Oral corticosteroid treatment for her active PIC lesions resulted in visual acuity improving from 6/12 to 6/6 1320288-19-4 manufacture in the left eye. It was noted that although treatment response was not easily determined on non-quantitative assessment of the SD-OCT images, reduction in lesion size could easily be detected and objectively measured using retinal thickness maps (Heyex?). Recurrent exacerbations of the disease resulted in increasing maintenance treatment (mycophenolate mofetil 1?g bid; oral prednisolone 10?mg od) with individual flares being treated with intravitreal corticosteroid; a choroidal neovascular membrane was treated with a course of intravitreal bevacizumab injections. Retinal thickness maps based on automated segmentation lines delineating internal limiting membrane and Bruchs membrane proved consistently reliable, showing focal retinal thickening in the form of hot spots at sites which were suspicious for new activity on SD-OCT (Table?1). 1320288-19-4 manufacture Following intravitreal steroid treatment, the thickness map returned towards baseline each time, corresponding with the resolution of symptoms (Fig.?1). Table 1 Outcomes of methods used to detect active PIC lesions in the patients left eye Fig. 1 Comparative retinal thickness maps and SD-OCT images from an active and subsequent quiescent phase of punctate inner choroidopathy lesions in the patients left eye. SD-OCT during a symptomatic flare-up showing focal disruption of the RPE and … These maps also enabled an estimation of what constituted a symptomatic deterioration. Comparing each active episode to the preceding quiescent visit showed Vegfa that the mean detectable change of retinal thickness associated with symptoms was 60.2?m (range 12C103?m). The average increase in retinal thickness during a flare in the inner (1?mm), middle (3?mm) and outer (6?mm) zones of the ETDRS macular grid was 18.2?m (range 10C33?m), 25.9?m (range 3C59?m) and 12.6?m (range 14C28?m), respectively, with more hot spots recurring in the middle, inner and outer zones in that order (Table?1). This patient has given specific consent for her clinical data and images to be published. Discussion A major challenge in managing patients with white dot syndromes is the lack of sensitive measures of disease activity that can provide objective guidance for treatment decisions. This is particularly important when dealing with sight-threatening conditions where systemic treatment with immunosuppressants may be indicated, such as PIC. Our patient was highly sensitive to visual symptoms in her only eye, but similar changes may often be missed by patients (e.g. if occurring in the worse-seeing eye). For the clinician, the changes in PIC may be subtle and may be missed on clinical examination or non-quantitative assessment of imaging. In our dedicated PIC clinic, all patients have longitudinally tracked retinal thickness maps facilitating detection of new lesions even in asymptomatic patients, guiding treatment decisions and quantifying treatment response. This case highlights how changes on these maps can easily be visualised, providing an objective correlate to the patients symptoms and enabling confidence in treatment. The use of these thickness maps enables rapid screening for new or changing lesions which can then be analysed in more detail on the b mode SD-OCT scans; thickness maps therefore augment rather than replace the b scans. This technique depends on accurate segmentation of the SD-OCT images, which can be readily checked prior to interpretation of maps. Extensive chorioretinal scarring may cause.