ABCA4 and Atrophy: Figure 4a shows imaging of her right eye in her 60 s. She had a large geographic area of RPE atrophy with a small subfoveal island of sparing visible on CFP and AF imaging. On CFP imaging, some yellow flecks are visible in the temporal macula. Hypo-AF and hyper-AF flecks were much more apparent on AF imaging, with peripapillary sparing. OCT showed extensive RPE and outer retinal atrophy in the macula, with a small central island of relative sparing. Genetic testing revealed two pathogenic ABCA4 missense variants (Table 1).