Good Hope Eye Clinic

Adult Bests / Adult onset foveomacular vitelliform dystrophy
/Bests vitelliform macular dystrophy (AOFVD)

David Kinshuck


macular degeneration of gass, diagram

The centre of the retina (the fovea) is affected,
leading to problems with central vision

This is a type of dry macular degeneration (ARMD), may be known as adult onset Bests disease. Alternatively, it is termed dry ARMD with drusenoid lenions...drusen or drussenoid retinal pigment epithelial detachment (Ophth13).

The damage is confined to the centre of the macula, the fovea. This is a very small central area, and has been described by Gass, and here. Generally the prognosis is good.

However, the retina does become thin in the affected area, and the sight may get slightly worse with ag as the retina thins. About 1/50 patients (with the thicker lesions) develop atrophy every year Ophth13.
A few patients do eventually develop wet ARMD, or other problems. However, this is not part of the condition, and is really coincidental.

Reticular pseudodrusen are often present Eye 16   photo


As with all types of ARMD, a healthy lifestyle may slow the condition down. It is likely smoking is extremely harmful: it is likely that smoking will promote significant progression and also the conversion into wet ARMD.

adult best oct and photo a very large drusen under the fovea: 6/24, very little change in the last 2 years 6/18 2 years ago

OCT and photo of onset foveomacular dystrophy

blue circle outlines the drusen-like material under the fovea


A case

vitelliform macular dystrophy in an adult patient

symptoms for 3 years, 6/18 vision both eyes


Another case

Basal laminar drusen and glomerulonephritis, can have viteliform lesions NOTE this. Also had cme.



  • Adult Bests may be associated with reticular drusen
  • Retina 2010   OCT changes AJO 2011    Unilateral BJO 12     HTRA1
  • Best vitelliform
    • Egg yolk,brilliant autofluourescence
    • oct space under rpe,
  • 4 stages, possibly 5th..cnv
  • Egg yolk breaks down to leave a space
  • choroidal thickness  Retina16
  • some dursenoid PEDs, especially if unilateral, may represent old central serous retinopathy


  • Retina 1
  • Bests  Bestrophin-1gene; gene vmd 2
  • 100 mostly mistsence mutations
  • accumulation of a2e, altered turnover of ros..rod out segment
  • Vmd2: rRecessive
  • may be multifocal best
  • Autosomal recessive bestrophinopathy
    • Recessive
    • Vitteliform
    • may be microcornea, narrow angles, microphthalmos