Normal Macula, Normal Fundus Image = Normal Eye? Not so fast.

As I have said may times before when vision is less than 20/20 it is our job to determine the cause.  What we have grow accustomed to over the years when the macula appears normal on fundoscopy or imaging is that we can rule out the macula as being involved.  Wrong.  As Jerry Sherman has revealed over and over in Retina Revealed when vision is down and the macula looks normal we if we have no other cause that explains the reduce acuity we should get out the OCT.  Cross sectional imaging which gets below what we can see with a scope or an image will often reveal an abnormality deeper in the retina. 

A paradigm shift is necessary.  A normal fundus image of the macula does not necessarily mean  that the macula is normal.  Without another explanation for reduced acuity we should always order an OCT scan of the macula.