Central serous chorioretinopathy, type 1 CNV, and the pachychoroid spectrum of diseases cause abnormalities in the choroidal circulation that make the overlying RPE dysfunctional, resulting in flat irregular PED. Discrimination between avascular and vascular flat irregular PEDs is crucial for a good visual outcome, but since chronic alterations of the RPE can compromise the diagnostic specificity of FA and ICGA, OCT angiography may become a fundamental tool to differentiate these clinical entities.