PURPOSE: To determine the characteristics of choroidal osteoma arising from a previously unreported patient population and to document new observations in this condition. DESIGN: Retrospective, observational case series. PARTICIPANTS: Eleven consecutive patients seen from 1986 through 2002 with choroidal osteoma from one community-based retina practice. INTERVENTION: Laser ablation of subretinal neovascularization in two cases and focal laser treatment of retinal pigment epithelial leaks in one case. METHODS: Photographs, fluorescein and indocyanine green angiograms, and clinical records were analyzed. MAIN OUTCOME MEASURES: Demographic variables, visual acuity, complications of laser treatment, growth of lesions, and associated funduscopic changes. RESULTS: Choroidal osteoma from a community setting is more frequently asymptomatic (5/11 cases; 45%) than in previously reported university series, is usually initially misdiagnosed, and is not rare. Light-intensity focal laser photocoagulation for serous retinal detachment unaccompanied by subretinal neovascularization can resolve fluid (1/11 cases; 9%). Laser ablation of secondary subretinal neovascularization stimulates rapid choroidal osteoma vascular remodeling (2/11 cases; 18%) and can cause retina-osteoma venous and arterial anastomoses (1/11 cases; 9%). Spontaneous choroidal hemorrhage unaccompanied by subretinal neovascularization can occur with confinement to the osteoma borders (1/11 cases; 9%). Association of choroidal osteoma with retinitis pigmentosa is reported. CONCLUSIONS: These data on choroidal osteoma natural history and treatment help clinicians managing these lesions. In the community, a higher index of suspicion for choroidal osteoma is warranted.