We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Proportionate Topographic Areas of Retinal Zones 1, 2, and 3 for Use in Describing Infectious Retinitis

Emmett T. Cunningham, MD, PhD, MPH; Larry D. Hubbard, MAT; Ronald P. Danis, MD; Gary N. Holland, MD
Arch Ophthalmol. 2011;129(11):1507-1508. doi:10.1001/archophthalmol.2011.331.
Text Size: A A A
Published online


Holland and colleagues1introduced the technique of localizing infectious retinitis lesions to 1 or more of 3 contiguous retinal zones in 1989, an approach first applied to the study of cytomegalovirus retinitis in patients with AIDS. As defined in the original study, zone 1 corresponded to an area comprising both 2 disc diameters (3600 μm) from the foveal center and 1 disc diameter (1800 μm) from the margins of the optic disc, an area wherein most immediately sight-threatening lesions reside2; zone 2 was defined as the area extending from zone 1 to the clinical equator of the eye, identified by the anterior borders of the ampullae of the vortex veins; and zone 3 extended from zone 2 to the ora serrata, an area underlying the vitreous base and associated with an increased risk of retinal detachment (Figure 1). Studies of retinitis location, size, and progression are often done photographically in collaboration with a certified reading center using standardized protocols, photographs, and measuring techniques.3 In general, there is good agreement both between individual reading center graders and between separate reading centers,4 whereas clinicians tend to consistently overestimate retinitis lesion size by about a factor of 2.5 The zonal system, as originally developed for cytomegalovirus retinitis, was adopted for the National Institutes of Health–sponsored Studies of the Ocular Complications of AIDS4 and has since been applied to other forms of retinitis, most notably ocular toxoplasmosis,6 but is distinct from the zonal classification (I, II, III) used in the study of retinopathy of prematurity.7

Figures in this Article


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Retinal zonal topography, modified after Holland and colleagues.1 One disc diameter is approximately 1800 μm.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Proportionate zonal representation as estimated from both photographic4 and human anatomical10 studies.*Zones 1 and 2 from NTS accession No. PB97-192082.4 †Zone 3 from Curcio and Allen.10 ‡Rounded to the nearest fifth percentile.




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

5 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.