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We highlight the use of multimodal imaging to diagnose and report what is, to our knowledge, a novel presentation of bilateral choroidal neovascularization (CNV) and prominent macular choroidal folds (CFs) in a patient with pattern dystrophy. An 81-year-old Caucasian male presented with painless, blurry central vision in both eyes. Color fundus photography, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), fundus autofluorescence, and brightness scan ultrasonography supported the diagnosis of pattern dystrophy with bilateral CNV and CF. In the right eye, visually significant CNV worsened post-bevacizumab treatment but responded well to aflibercept. During 4-year follow-up, Snellen visual acuity remained excellent in both eyes at 20/20, including the treatment-naïve left eye. CFs remained markedly stable in both eyes.