Visual function abnormalities in macular heterotopia caused by proliferative diabetic retinopathy.

In seven patients with displacement of the macula in one eye caused by vitreoretinal traction from proliferative diabetic retinopathy, the macula was displaced toward the optic disk in all but one eye. The eyes with macular heterotopia showed (1) reduced visual acuity (ranging from 6/6 (20/20) to 6/24 (20/80), (2) reduced static perimetry sensitivity (particularly in the temporal field) with displacement of the peak sensitivity toward the blind spot, (3) loss of hue discrimination, and (4) metamorphopsia. In two eyes with macular heterotopia, Stiles-Crawford data provided evidence for photoreceptor disorientation; one eye had mixed orientation, and the other a displaced peak suggesting regular photoreceptor tilting. The proposed mechanisms of visual loss in eyes with macular heterotopia secondary to traction from proliferative diabetic retinopathy include detachment of the macula, disorientation of photoreceptors in the macula, and disturbance of normal neural connections within the retina caused by stretching of the retina.