Figure 10.

Diagram illustrating the proposed model for the changes in the fundus of a patient with pseudoxanthoma elasticum showing the changes that can be seen on different imaging methods. In the early disease stages, a predefined area for Bruch’s membrane (BM) calcification already exists. This has a speckled aspect known as peau d’orange. This area will fill up with more confluent BM calcification over time that presents as an increased fundus reflex. Over time, a pattern of decreased indocyanine green angiography (ICGA) fluorescence appears that starts in the macula and spreads centrifugally. This model is a modification from the model as proposed by Charbel Issa et al.¹⁰