There are a few things that a clinician will see in practice on a day to day basis that will give you a shock, then once you get your thoughts together you realize there isn’t much you can do except to refer out for observation. That was no exception this week.
A patient was scheduled for just a routine eye exam (26-year-old African American female). No vision issues noticed. Just a young lady who wanted to update her contact lens prescription. There were no notations on her paperwork that she had ever been diagnosed with any eye condition in the past, so when I took her Optomap photos I was surprised to see what I first thought was a very large nevus. Upon further investigation, I found that it was a CHRPE.
Congenital Hypertrophy of the Retinal Pigment Epithelium or CHRPE is a spot on the retina, or back of the eye, that is normally black in color and benign. The pigmented layer of the retina is the retinal pigment epithelium (RPE). It is the cell layer just outside the neurosensory retina that nourishes retinal visual cells. It is a very thin layer found between the photoreceptor layer of the retina and Bruch’s membrane and the choroid. When a person is born, they can have hypertrophic spots of RPE cells. These cells are called a CHRPE.
After seeing my fair share of retinal tumors, these spots can be alarming, however, the risk of the spots becoming cancerous is very low. They are common, and a patient may have just one lesion. There is the possibility of Familial Adenomatous Polyposis. This is an inherited condition in which adenomatous polyps form mainly in the epithelium and in the large intestine. While these polyps start out benign in the large intestine, these lesions can become malignant and turn into colon cancer if not diagnosed and treated early. Most patients with this syndrome will have multiple lesions. If this is the case, the patient will need to be referred to a gastrointestinal specialist.
Optomap showing CHRPE to the right of the optic nerve disc
Optomap showing myopic degeneration
Learn more about the importance of understanding and controlling myopia in our CE, Controlling Myopia in Children at www.2020mag.com/ce.