Chorioretinal folds are unique optical distortions that indicate underlying conditions affecting vision. If you've noticed changes in your sight or have been diagnosed with these folds, connect with experienced retina specialists who can provide the necessary support and monitoring. Our listed practices are here to help you navigate and manage your eye health.
Chorioretinal folds are a pattern of light and dark lines—like ripples or grooves—seen at the back of the eye, usually around the posterior pole. These folds form due to slight waves or indentations involving three key layers: the choroid, retinal pigment epithelium (RPE), and the overlying retina. They may run in parallel, horizontal, vertical, oblique, or irregular directions.
Chorioretinal folds are physical distortions in the eye's inner layers. Originally referred to as choroidal folds, the term evolved to chorioretinal folds to reflect the involvement of multiple layers of the eye.On imaging, such as fluorescein angiography, they appear as alternating bright and dark bands, reflecting the peaks and valleys of the folds.
Chorioretinal folds can affect vision depending on their location and severity, especially if they involve the macula, the part of the eye responsible for sharp central vision. In some cases, the folds are discovered incidentally during a routine eye exam, as not all patients experience noticeable symptoms.
However, when symptoms do occur, they may include:
Straight lines may appear wavy or distorted, particularly if the folds interfere with the macular region.
Patients may experience blurry or reduced vision, either temporarily or long term, if the folds disrupt the precise layering of the retina.
In some cases, the folds can cause the back of the eye to flatten, leading to a hyperopic shift (farsightedness), known as acquired hyperopia.
Chorioretinal folds themselves do not stand in isolation; they are often linked with a range of other ocular and systemic conditions. It’s also worth noting that chorioretinal folds can occur in either one eye (unilaterally) or both eyes (bilaterally). Unilateral folds are often linked with significant ocular issues like scleritis or tumors, while bilateral presentations tend to be associated with systemic conditions such as thyroid disease or are sometimes found without a clear causative factor. Here’s the thing: identifying the underlying cause is a critical step in management, because these folds can be a sign of other potentially significant issues. Here are some of the common contributing factors:
Changes in the shape of the eye can lead to a hyperopic shift, which is frequently associated with the presence of chorioretinal folds.
Inflammation in the back of the sclera can produce thickening and subsequent undulations in the choroid and retinal layers.
Masses within the orbit or behind the eye can exert pressure that causes folding of the retina and choroid.
Also known as Grave’s ophthalmopathy, this condition can lead to orbital tissue expansion and gravitational forces that create these folds.
Lesions within the choroid can distort the normal architecture of the retinal layers, leading to folds.
Procedures such as scleral buckling for retinal detachment or conditions like hypotony after trabeculectomy may result in structural changes that manifest as folds.
When no obvious cause is found, the folds are referred to as idiopathic. Some experts suggest that subtle, prior episodes of chronic inflammation or posterior scleral thickening may be responsible.
Accurate diagnosis of chorioretinal folds is crucial and typically relies on a combination of imaging modalities. Here’s how our retina specialists go about evaluating this condition:
This imaging test is vital because it displays the alternating hyperfluorescent and hypofluorescent streaks that define these folds. The pattern seen on FA helps distinguish chorioretinal folds from other types of retinal or choroidal abnormalities.
OCT is indispensable in assessing the structural relationships among the retina, RPE, and choroid. For chorioretinal folds, OCT images reveal that these layers are folded in a similar pattern, maintaining their overall thickness in a largely preserved configuration, albeit with some flattening of the inner retina on the crests.
If you're experiencing visual disturbances or have concerns about chorioretinal folds, don't hesitate to seek a consultation with a top optometrist or ophthalmologist. Practices listed with Specialty Vision specialize in comprehensive eye care and can provide personalized evaluations and treatment options. Find a trusted eye care professional near you today!
In cases where the physical shape of the ocular wall is questioned, B-scan ultrasonography can provide helpful cross-sectional images that may show a flattening or thickening due to the folds.
When orbital or intracranial pathology is suspected as an underlying cause, these imaging modalities can help assess the broader anatomical context. For example, they can reveal an enlarged optic nerve or a distended peri-optic subarachnoid space, both of which may be associated with the formation of chorioretinal folds.
There is no universal treatment for chorioretinal folds. Instead, management focuses on identifying and addressing the underlying cause, monitoring for changes, and preventing vision-threatening complications. The goal is to protect visual function while minimizing progression or recurrence.
Chorioretinal folds can be a sign of an underlying systemic or orbital disorder, such as:
A full medical history, physical exam, and additional testing—including bloodwork, neuroimaging (MRI/CT), and orbital ultrasound—may be recommended to rule out these conditions.
Close observation is critical, especially in patients without clear symptoms or when folds are found incidentally. Monitoring may involve:
This ongoing surveillance allows early detection of secondary complications, such as:
Chorioretinal folds may cause a hyperopic shift (farsightedness), especially if they flatten the posterior globe. In such cases:
If complications arise, such as choroidal neovascularization or maculopathy, early intervention is key. Treatment may include:
Yes, sometimes these folds are detected during routine imaging without any noticeable impact on vision. However, if the macula is involved, patients may experience subtle changes in visual acuity or distortion.
Fluorescein angiography, which shows the characteristic alternating pattern of hyperfluorescence and hypofluorescence, is key in diagnosing chorioretinal folds. OCT further adds detailed insights into the structural relationships of the retinal layers.
Not necessarily. While they can be an indicator of underlying issues like thyroid eye disease, posterior scleritis, or intraocular tumors, many cases with chorioretinal folds remain stable, especially when no other serious ocular pathology is present.
Management mainly involves ongoing observation and identifying any underlying cause. When associated complications such as a maculopathy develop, targeted interventions are initiated to prevent further vision loss.
The folds can be unilateral or bilateral. Unilateral presentations may be associated with more significant ocular findings like orbital masses or local inflammation, whereas bilateral folds are often linked with systemic conditions or remain idiopathic.
These frequently asked questions help shed light on the diverse aspects of chorioretinal folds and underscore the importance of a thorough and individualized evaluation by our retina specialists.
If you're experiencing visual disturbances or have concerns about chorioretinal folds, don't hesitate to seek a consultation with a top optometrist or ophthalmologist. Practices listed with Specialty Vision specialize in comprehensive eye care and can provide personalized evaluations and treatment options. Find a trusted eye care professional near you today!
Chorioretinal folds can impact vision. Find a top optometrist or ophthalmologist near you for diagnosis and management of this condition.
