Pavingstone Degeneration

Pavingstone (cobblestone) degeneration is characterized by peripheral, small, discrete areas of atrophy of the outer retina. Sometimes, the lesions may coalesce into a band like zone of degeneration or may occur singly. It is present in 22-27% of general population and 33% are bilateral.

Pavingstones are characterized by atrophy of the RPE and outer retinal layers, attenuation or absence of the choriocapillaris, and adhesions between the remaining neuroepithelial layers and Bruch's membrane. Large choroidal vessels may be visible beneath the lesions due to the absence of the RPE.

Ophthalmoscopically, they appear yellowish-white and may be surrounded by rim of hypertrophic RPE. The lesions are most common in inferior quadrants, anterior to the equator.