What does this white pupil spot indicate?

George, a 64-year-old retired metal worker, presents complaining of vision loss.

A white spot is evident within the pupil margin (pictured in the quiz).

He is generally well, and the eye appears grossly normal otherwise.

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Dr Alex Ioannidis is an ophthalmologist with a special interest in anterior segment conditions and laser cataract surgery. He practises in Melbourne, Vic