LAUSR

Evaluating Retinal Histology Using Multimodal Imaging: A Case Study of Coats Disease Coats disease is an idiopathic retinal disorder that is characterized by a spectrum of vascular abnormalities.1 Since the original report by George Coats in 1908,2 several detailed histopathologic studies have collectively documented the cellular changes that underlie the clinical manifestations of this disease such as blood–retina barrier breakdown, vascular dilatation, and retinal degeneration.3–5 The era of multimodal imaging has facilitated clinical examination of retinal diseases at a subcellular level in a way that could previously only be achieved through postmortem histologic techniques. We use a case of bilateral Coats disease as an exemplar to show that the histologic characteristics of retinal diseases can largely be appreciated using multimodal imaging. A 51-year-old asymptomatic and healthy man was referred for further evaluation of telangiectatic vascular changes in both maculae (Figure 1). Hypertension and diabetes mellitus were excluded by the family physician. Changes were more pronounced on the right side than the left. Best-corrected visual acuity was 20/20 in both eyes. Fluorescein angiography (FA) revealed diffuse leakage due to blood– retina barrier breakdown at sites of telangiectatic vascular changes (Figure 1).3 Acellularity of vessel walls due to vascular fibrosis was best appreciated on color photography and seen inferotemporal to the right macula.4 Comparisons between color imaging, red-free photography, FA, and optical coherence tomography (OCT) revealed the different histologic