We appreciate the interest and comments on our article. The spectral-domain optical coherence tomography (SD OCT) scan image from a 64-year-old woman in Figure 2 might be similar to adult-onset vitelliform dystrophy. However, the final diagnosis was made as neovascular age-related macular degeneration (AMD) in our article, based on the following findings. First, fundus photography showed soft drusen and reticular pseudodrusen in both eyes. A small yellowish lesion in the left eye appeared to be hard exudate. Subretinal fluid and subretinal fibrinoid materials were observed in the left eyes, which were different from typical yellowish vitelliform lesions and pseudohypopyon. Second, fluorescein angiography showed a well-demarcated hyperfluorecent lesion at early phase with progressive leakage in the left eye. Vitelliform lesions usually show hypofluorescence. Third, SD OCT raster scan images at different positions showed multiple elevations of retinal pigment epithelium with focal disruption of the retinal pigment epithelium and Bruch membrane complex. Fourth, the right eye showed no subretinal or subretinal pigment epithelial changes or fluid, similar to those in the left eye. In this case, we recommended further imaging tests including fundus autofluorescence imaging and indocyanine green angiography. However, the patient was not followed up further.
It has been known that acquired vitelliform lesions could be accompanied with reticular pseudodrusen, in addition to cuticular drusen and nonneovascular AMD. Furthermore, acquired vitelliform lesions are sometimes complicated with choroidal neovascularization. Therefore, multimodal imaging tests are needed for differential diagnosis of presumed neovascular lesions in eyes with reticular pseudodrusen.