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Purpose To share an unusual retinal finding. Design Case report. Subjects Co-author and progeny. Methods Interval retinal examinations and images compared to asymptomatic baseline decades before. Available progeny also imaged. Main Outcome Measure Autofluoresce widefield retinal images over time. Results Symmetric, asymptomatic, pattern retinal findings resembling tilted flying eagles in did not progress over two years, but were not apparent on retinal color photos from 28 years before. Conclusions Widefield, non-mydriatic imaging may have uncovered a unique retinopathy.

Purpose To present a case series of ocular findings of West Nile virus infection (WNVI) in North America. Design Retrospective, noncomparative, observational case series. Participants All patients were referred to the authors for WNVI with ocular involvement between the years 2002 and 2005. Methods Chart review was performed on all participants. All participants underwent complete ophthalmic evaluation during each examination, including best-corrected Snellen visual acuity measurement, tonometry, slit-lamp biomicroscopy of the anterior and posterior segments, and dilated fundus examination with indirect ophthalmoscopy. Fundus photography and fluorescein angiography were also performed on all eyes. Relevant ocular findings associated with WNVI were recorded and tabulated. Main Outcome Measures The authors studied the characteristics, frequency, and locations of ocular lesions found in participants' eyes. Results There were 14 eyes (7 patients) with ocular West Nile virus lesions from 2002 to 2005. Average patient age was 58.4 years (range, 32–85 years). Ocular findings in descending order of frequency included multifocal chorioretinal target lesions in 12 eyes (85.7%), retinal hemorrhages in 7 eyes (50.0%), vitritis in 6 eyes (42.9%), chorioretinal linear streaks in 4 eyes (28.6%), perivascular sheathing and vasculitis in 4 eyes (28.6%), narrowed retinal vessels in 4 eyes (28.6%), disc edema in 4 eyes (28.6%), optic atrophy in 2 eyes (14.3%), vascular occlusion in 2 eyes (14.3%), and VIth nerve palsy in 1 eye (7.1%). Peripheral fundus lesions were found in all 14 eyes (100%), whereas posterior fundus lesions were found in 8 eyes (57.1%). Five patients (71.4%) were diabetic. Diabetic retinopathy was present in 7 eyes (70%). Conclusions Multifocal choroiditis is the most common ocular manifestation associated with WNVI, with a typically benign clinical course. Less frequent ocular lesions, including optic neuritis and occlusive vasculitis, frequently induce persistent and likely permanent visual deficit. Diabetic patients and those older than 50 years of age are more vulnerable to the more severe features of WNVI, including more serious ocular lesions.

Objective To investigate the feasibility, acceptability, efficacy, and cost of a newly developed translucent shield that can be fixed by sutures to the orbital rim for a month of amblyopia therapy. Methods In an institutional review board–approved protocol for patients with amblyopia who do not adhere to the use of conventional patching, shield occluders were fashioned from heat-moldable sturdy black or translucent (20/4000) plastic with holes drilled for attachment. Under brief general anesthesia, patients aged 5 to 10 years had a thorough examination before the shield occluder was sewn to the brow and cheek of the nonamblyopic eye with 3-0 monofilament polypropylene sutures. Results Ten children completed this protocol from December 1999 through January 2002. All tolerated the occluder for 12 to 36 days. The resultant skin scars were acceptable to parents, patients, and investigators. The amblyopic eyes improved from a mean (SD) of 0.77 (0.30) logMAR (Snellen equivalent, 20/119) to 0.45 (0.29) logMAR (Snellen equivalent, 20/57), a change of 0.32 (0.16) logMAR lines. There was no damage to the sound (occluded) eye. Conclusion Sew-on occluder shields are an alternative when adherence to the use of other types of patching (often referred to ascompliance with patching) is not satisfactory.