Normal branch retinal arteries are about 100 microns in diameter while branch retinal veins are about 175 microns in diameter. The venous circulation has a noticeably darker purple-red color as well which is well seen in this patient's photographs. Ophthalmoscopic features of autosomal dominant Best disease include a round to horizontally oval "vitelliform" (egg-yolk-like) deposit of yellowish material between the photoreceptors and the RPE. The vitelliform lesion can range in diameter from 250 microns to more than 3 mm. Large Best lesions can be present as early as the first few years of life and small ones can first become manifest after age 50. The modifying factor(s) responsible for this variable expressivity are currently unknown. Mutations in RDS (aka PRPH2) can also cause vitelliform lesions but the latter are less likely to be as large or to have the very smooth borders seen in this individual. The shiny retinal surface seen in the 60 degree photographs is common in patients under the age of 20.

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