Preventing vision loss in advanced primary care through asynchronous teleophthalmology: early detection of asymptomatic sight-threatening retinal vasculitis in a young adult

Asynchronous store-and-forward teleophthalmology embedded within primary care clinics can detect asymptomatic sight-threatening ocular disease beyond diabetic retinopathy. We report a case of asymptomatic retinal vasculitis identified during routine tele-eye screening in a young adult. A man in his early 20s with no known significant medical or ocular history presented to a primary care clinic for a routine physical examination. As part of an advanced primary care initiative, non-mydriatic external eye and 45° posterior fundus photographs were obtained using an automated eye camera and reviewed remotely through a secure teleophthalmology platform. The left fundus photograph demonstrated venous sheathing and intraretinal haemorrhages involving the macula. Urgent in-person retina evaluation revealed active undifferentiated occlusive retinal vasculitis threatening the fovea despite preserved 20/20 vision. Workup also revealed a heterozygous prothrombin factor II G20210A mutation. Prompt systemic immunosuppression achieved disease control without visual loss. This case highlights teleophthalmology’s ability to identify occult vision-threatening disease before symptom onset.