Background Microcystic macular changes, also called microcystic macular oedema, have recently been reported in patients with multiple sclerosis, particularly after optic neuritis. But it has since emerged that the finding is not specific for optic neuritis. This study was designed to prospectively investigate the prevalence of microcystic perifoveal changes in patients with optic atrophy not due to optic neuritis.

Methods A prospective, cross-sectional study including 54 patients with a history of optic atrophy and 54 healthy control subjects. Spectral domain optical coherence tomography (SD-OCT) was used to scan the macular area and to measure the peripapillar retinal nerve fibre layer thickness. Scanning laser ophthalmoscopy (SLO) was used for imaging of the macular area.

Results Microcystic macular changes were present in 11/54 patients (20.4%), 17/90 eyes with optic atrophy (18.9%) and absent in the normal eyes of patients with monocular optic atrophy and all healthy control eyes. No correlations were found with the age, duration of optic atrophy or severity of optic atrophy. Besides the known perifoveal (semi) circular abnormal reflexes on SLO imaging, we also noticed a more patchy pattern of low SLO reflections in some patients with optic atrophy.

Conclusions Microcystic macular changes are a frequent observation in patients with optic atrophy of another cause than optic neuritis. The cause of these abnormalities remains a matter of debate. It is important for clinicians to recognise these macular changes and to realise that the cause may lie remotely away from the macula.