A 25-year-old man had experienced diminished vision in the right eye for several months. There was no history of ocular injury or inflammation. His perinatal and family histories were unremarkable. Best-corrected visual acuity was 20/80, N12 OD and 20/20, N6 OS, with low myopic correction. The anterior segment was unremarkable in each eye. Fundus examination of the right eye revealed macular pucker and peripheral telangiectasia with exudation, suggestive of Coats disease. Fundus examination of the left eye revealed 2 parafoveal halos with 2 foveal reflexes; the temporal reflex was slightly distorted (Figure, A). No other ocular structure exhibited duplication. Optical coherence tomography using a Stratus OCT 3 (Carl Zeiss Meditec, Dublin, California) supported the clinical appearance of foveal duplication: the temporal fovea demonstrated a similar slope of clivus and the recession of inner retinal layers as the central fovea. However, the recession was not complete; a thin layer of inner retinal neurons remained above the photoreceptor layer, the probable cause of blunted foveal reflex. Despite additional layers, the central fovea (thickness, 165 μm) and the accessory fovea (thickness, 160 μm) were similar in thickness, probably owing to less-elongated photoreceptors in the latter (Figure, B). Fundus fluorescein angiography demonstrated only 1 foveal avascular zone, corresponding to the central fovea. A nonspecific mottled hypofluorescence was observed in the area of the temporal fovea (Figure, C). Fundus fluorescein angiography of the right eye revealed leaking telangiectasia and avascular areas in the inferotemporal periphery. Orthoptic evaluation revealed no fixation abnormalities in the left eye; the patient fixed consistently with the central fovea. Automated perimetry using the central 10-2 threshold test protocol (model 720i, Humphrey Field Analyzer II; Carl Zeiss Meditec) showed a normal foveal threshold (31 dB) at the fixation point, with a typical gradient of reducing sensitivity toward the periphery; no anomalous increase in sensitivity was registered temporal to the fixation point (central fovea). The patient was advised, but declined, to undergo pars plana vitrectomy and endophotocoagulation in the right eye.