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It is unsurprising that Barouch and colleagues¹ found no transthyretin mutation in their 70-year-old patient because the eye in question had many of the characteristics of asteroid hyalosis rather than vitreous amyloidosis.² For example, the clinical picture from their report shows spherules of varying sizes populating condensed vitreous fibrils to form "strings of pearls" (Figure 1A). This is quite unlike the vitreous gel in familial amyloidosis wherein variant transthyretin coats the vitreous fibrils diffusely (like "glass wool"), enabling the otherwise invisible gel microarchitecture to become manifest.^3-4 Thus, amyloid precipitation onto remnants of the tunica vasculosa lentis will appear as "pseudopodia lentis" on biomicroscopy of the anterior vitreous before and after vitreous surgery.⁵ The subretinal deposits in their Figure 1B, which may have been drusen, were probably incidental.

Admittedly, the deposition of amyloid proteins in vitreous tends to be symptomatic and bilaterally symmetrical (presenting features in their patient), whereas asteroid hyalosis . . . [Full Text of this Article]

AUTHOR INFORMATION
David McLeod, MB, ChB, FRCOphth; Richard Bonshek, MD, CM, FRCPath

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Amyloid or Asteroid?—Reply
Fina Barouch, Shizuo Mukai, and Merrill Benson
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