Macular OCT scan of patient with right occipital lobe demonstrates a homonymous pattern of macular thinning (a). The macular line scans (b) demonstrate the corresponding thinning of the nasal macula in the right eye and the temporal macula in the left. Previously only congenital abnormalities posterior to the lateral geniculate were thought to cause changes in the visual system anterior to the lateral geniculate body. However, this case and others in the peer-reviewed literature clearly indicate that trans-synaptic degeneration may occur.