A 9-year-old healthy boy was seen for long-standing poor vision in his left eye. The right eye was healthy. His visual acuity was 20/400 OS with a normal anterior segment. Ophthalmoscopic examination results revealed a combined hamartoma of the retina and retinal pigment epithelium. Combinedhamartomaoftheretinaandretinalpigmentepithelium isarare,benign,congenital,andhamartomatousmalformationthatwas first described by Gass. 1 These lesions are typically unilateral; bilateral presentation is more frequently associated with phakomatoses, such as neurofibromatosis, for which the patient had negative genetic testing results. 2,3 Combined hamartomas can have a variable appearance and location but are typically gray-blue with thickened preretinal tissue that can contract and displace surrounding retina and blood vessels (Figure ). 4 Which specific retinal layers are involved can differ between patients; a recent classification scheme has been proposed to betterdescribethesetumors. 5 Combinedhamartomasoftheretinaand retinalpigmentepitheliumcancausesubstantialvisionloss,andsurgery may be required if retinal detachment occurs. 6