Systemic Workup Helps Identify Silent Disease in Patients with Acute Isolated PAMM

In this small study involving 36 patients with acute isolated paracentral acute middle maculopathy, the majority had abnormal findings in their systemic evaluations, most frequently on brain imaging. Photo: Hostovsky A.Ophthalmology. December 7, 2025. Click image to enlarge. Characterized by hyperreflective bands in the inner nuclear layer, paracentral acute middle maculopathy (PAMM) is an OCT finding that serves as a potential biomarker for systemic microvascular dysfunction and is associated with conditions like hypertension, diabetes and cardiovascular disease. A new small study highlights the value of a thorough systemic workup, including brain and carotid imaging and echocardiography, in patients presenting with isolated PAMM (iPAMM), revealing that most had abnormal systemic findings.The retrospective cohort study, published on Sunday in Ophthalmology, included 37 patients diagnosed with acute iPAMM at a large medical center in Israel between 2015 and 2025. All patients initially presented to the ophthalmology emergency department with new-onset visual symptoms suggestive of iPAMM, such as paracentral scotoma or blurred vision, and the condition was confirmed on OCT. Structured systemic workups were performed on 36 of 37 patients, including brain imaging via MRI or CT angiography, carotid imaging via Doppler or CT angiography, echocardiography and Holter monitoring. Twenty-four patients completed the entire gamut of testing, while the others underwent at least one component..Among the evaluated participants, 21 out of 33 patients (63.6%) displayed abnormal findings, highlighting a high diagnostic yield from the systemic evaluations. Specifically, brain imaging uncovered abnormalities in 16 out of 29 patients (55%), while carotid imaging revealed issues in eight out of 33 patients (24%). Echocardiography identified abnormal results in six of the 30 patients (20%). Monitoring did not reveal any new significant abnormalities.The study further emphasized the importance of age as a determining factor for diagnostic yield, noting that patients aged 65 years and older had an alarming abnormal finding rate of 87.5%, a stark contrast to younger patients (40 years and below), who showed no abnormalities. PAMM subtype also influenced systemic findings; notably, carotid disease was more common in patients with globular PAMM (as opposed to arteriolar or perivenular). According to the researchers, this data suggests that structured diagnostic testing in patients with acute iPAMM could help reveal cerebrovascular or cardiovascular conditions that may otherwise go undetected. They noted that the patients in this study had multiple cardiovascular risk factors, and nearly two-thirds had abnormal systemic findings, “most frequently on brain imaging, followed by carotid and cardiac studies.” Also interesting is that “seven of 16 patients with abnormal brain imaging had no prior history of stroke, underscoring PAMM’s role as a marker of occult cerebrovascular disease,” the authors wrote. The study’s modest sample size and retrospective design limit the significance of this data. Moreover, it’s important to remember that these “findings apply specifically to patients presenting with new acute visual symptoms in whom OCT was performed as part of the diagnostic evaluation and iPAMM was identified as the cause of the presenting complaint,” the authors cautioned, adding that “this population differs from patients in whom PAMM is discovered incidentally during routine imaging or follow-up.”In conclusion, the authors contend, “Given the markedly higher diagnostic yield in older individuals, systemic evaluation is strongly recommended for patients over 40, particularly those aged ≥65 or with cardiovascular risk factors, while a selective approach may be reasonable in younger, otherwise healthy patients.” Click here for the journal source. Hostovsky A, Peled I, Katz G, Leshno A, Fogel Levin M. High yield of systemic workup in patients with acute isolated paracentral acute middle maculopathy. Ophthalmology. December 7, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.