The authors report adaptive optics scanning laser ophthalmoscopy (AO-SLO) findings in a case of acute posterior multifocal placoid pigment epitheliopathy. The right eye showed an island of coarse, hyperreflective speckles surrounded by a dark annulus lacking cone cells, which were associated with reduced MP1 sensitivity and abnormal findings in other imaging modalities. Although dark lesions were also detected in the left eye, the correlated spectral-domain optical coherence tomography images were normal. AO-SLO allowed for the direct observation of retinal disruptions and the ability of this technology to detect abnormalities in the left eye demonstrates a superior ability for in-depth retinal imaging.