OBJECTIVE Clinical evaluation of cystoid macular edema (CME), known to occur in patients with retinitis pigmentosa (RP), is based on the presence of vascular leakage on fluorescein angiography. Due to an inability to quantitatively assess retinal thickening, the degree of thickening from fluid accumulation and its relation to fluorescein dye leakage into the extravascular retinal space has not been established. The relationship between fluorescein dye leakage and foveal thickening and the effect of methazolamide treatment was studied. METHODS The retinal thickness analyzer was used to measure the degree of thickening in six patients with RP and CME. A laser beam was projected at an oblique angle to the retina, and images of the intersection of the laser slit with the anterior and posterior retinal surfaces were recorded. The digitized images were analyzed using a dedicated software program to provide quantitative measurements of retinal thickness. Routine fluorescein angiography was performed. RESULTS The amount of fluorescein dye leakage was not indicative of the degree of retinal thickening due to fluid accumulation. Foveal thickening and fluorescein dye leakage were reduced in five of six eyes after methazolamide treatment. Eyes with moderate thickening reversed to normal, whereas eyes with severe thickening showed only a minimal reduction in thickness. CONCLUSIONS Retinal thickness measurement is a useful method of evaluating both the extent of and changes in retinal thickness after carbonic anhydrase treatment.