Seven years follow-up of a case of acute zonal occult outer retinopathy

We describe the case of a 43-year-old South Asian man who presented with a long-standing history of gradual narrowing and blurring of his side vision. Despite maintaining normal visual acuity, multimodal imaging at presentation already revealed signs of chronic outer retinal and choriocapillaris involvement, suggesting that the disease had been present for some time before his first visit. Fundus autofluorescence (FAF) demonstrated a trizonal degeneration pattern, fundus fluorescein angiography showed peripapillary hyperfluorescence consistent with chronic retinal pigment epithelium (RPE) and choriocapillaris damage, and optical coherence tomography (OCT) revealed inner segment–outer segment disruption with subtle choroidal hyperreflectivity. Over follow-up, FAF transitioned to hypoautofluorescence, and OCT demonstrated further loss of the photoreceptor–RPE complex with increased choroidal reflectivity. This case highlights the value of multimodal retinal imaging in recognizing pseudo-bitemporal hemianopia of retinal origin, avoiding unnecessary neurological investigations, and identifying the chronic nature of acute zonal occult outer retinopathy (AZOOR).