Paving-Stone Degeneration

Paving-stone (or cobblestone) degeneration is characterized by peripheral, small, discrete areas of atrophy of the outer retina; it appears in 22% of individuals older than 20 years (Fig 16-10). The atrophic areas may occur singly or in groups and are sometimes confluent. On histologic examination, these “paving stones” are characterized by atrophy of the retinal pigment epithelium (RPE) and outer retinal layers, attenuation or absence of the choriocapillaris, and adhesions between the remaining neuroepithelial layers and Bruch membrane. These lesions are most common in the inferior quadrants, anterior to the equator. Ophthalmoscopically, they appear yellowish white and are sometimes surrounded by a rim of hypertrophic RPE. Because the RPE is absent or hypoplastic, large choroidal vessels are visible beneath the lesions.

Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.