Clinical spectrum of choroidal nevi based on age at presentation in 3422 consecutive eyes

Purpose: To evaluate the clinical features of choroidal nevi based on patient age at presentation and to investigate features of the nevi that are predictive of patient symptoms. Design: Observational case series. Participants: Three thousand four hundred twenty-two consecutive eyes of 3187 patients. Methods: Retrospective clinic-based study of clinical features at referral. Cox proportional hazards regressions were used for evaluation of factors predictive of patient symptoms. Main Outcome Measures: Nevus features as related to patient age group at diagnosis (young [<= 20 years], mid-adult [21-50 years], older adult [> 50 years]) and factors predictive of patient symptoms secondary to the nevus. Results: Of the 3422 eyes with choroidal nevus, 63 (2%) were in young patients, 795 (23%) in mid-adults, and 2564 (75%) in older adults. The following factors showed no substantial increase or decrease by age category (young, mid-adult, olderadult) at presentation: symptoms (14%,12%,13%), mean nevus base (5.6, 4.7, 5.2 mm), intrinsic nevus pigmentation (89%, 74%, 77%), related subretinal fluid (SRF) (11%, 15%, 9%), overlying orange pigment (6%, 10%, 6%), retinal pigment epithelial hyperplasia (0%, 9%, 7%), and retinal pigment epithelial atrophy (2%, 13%, 10%). The following factors statistically increased with age category: multiple nevi per eye (2%, 8%, 10%) (P = 0.0001), mean nevus thickness (1.2, 1.5, 1.6 mm) (P < 0.0001), and overlying drusen (11%, 40%, 58%) (P < 0.0001). Using multivariate analysis of the entire group, factors predictive of any symptom included nonpigmented nevus (P < 0.001), location <= 3 mm to foveola (P = 0.001), subfoveolar fluid (P = 0.002), any SRF (P = 0.02), and subfoveolar nevus (P = 0.027). Conclusions: Choroidal nevi show similar clinical features regardless of age of presentation, with the exception of increasing number of nevi per eye, slightly increasing thickness, and increasing drusen in adults versus younger patients. Symptomatic nevi are more likely to be nonpigmented, beneath the foveola, and with subfoveolar fluid.