The patient was a 64 year old white man who complained of “kaleidoscope” episodes lasting 5-20 minutes in the right eye for two years. The episodes had increased in frequency such that there was one or more daily when he saw us. He said that stress and bright lights seemed to increase his symptoms. He had been in good general health and had no other significant ocular history. He said that he sometimes had headaches associated with the episodes but not at other times. He had been in good general health and had no systemic complaints.
The visual acuity was 20/20-2 OD and 20/20-1 OS. Eye pressures were normal. The anterior segment examination was remarkable for a mild nuclear sclerotic cataract in each eye. Both optic nerves and maculas looked good. There were peripheral intraretinal hemorrhages in the right eye. The OCT of the right eye showed mild edema. The OCTA and autofluorescence of each eye were unremarkable. The fluorescein angiogram of the right eye revealed normal filling times, mild temporal peripheral ischemia with staining of peripheral blood vessels. There was late perifoveal leakage without disc leakage. The FA of the left eye was unremarkable. What are the diagnostic considerations? What further evaluation would you recommend?