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80-year-old woman has age-related macular degeneration in both eyes. She was in Indiana over the summer. She noticed since she was last here in March that the vision in the right eye has substantially declined. VISUAL ACUITY: OD: 20/400; OS: 20/50. IOP: OD: 14, OS: 20. The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: C/D ratio is 0.5. There is hyper-pigmentation temporal to the fovea. There is de-pigmentation under the fovea with thickening of the retina centrally. OS: Vertical C/D ratio is 0.5. There are patchy drusen and pigment spots. There is no subretinal fluid, hemorrhage or exudate. The OCT scan of the right eye shows retinal atrophy with edema inferior and temporal to the fovea. The left eye has retinal atrophy overlying thickened pigment epithelium with no intraretinal or subretinal fluid. A fluorescein angiogram of the right eye shows a typical hyperfluorescent spot nasal to the fovea and involving the fovea, characteristic of a retinal pigment epithelial rip. The left eye has some staining macular drusen. The right eye does have hyperfluorescence in the area of the pigment epithelial detachment showing a low-grade occult neovascular membrane. IMPRESSION: 1. WET AGE-RELATED MACULAR DEGENERATION IN THE RIGHT EYE. 2. RETINAL PIGMENT EPITHELIAL RIP IN THE RIGHT EYE. 3. DRY AGE-RELATED MACULAR DEGENERATION IN THE LEFT EYE. 4. MACULAR EDEMA IN THE RIGHT EYE. DISCUSSION: I explained to the patient that the right eye does have, unfortunately, a retinal pigment epithelial rip, which has caused severe central vision loss. She also, in addition to that, has wet age-related macular degeneration and I suggested a treatment with Avastin to dry up the macula and improve the vision. I have had some patients in that situation sometimes benefit from therapy. Her photos from August of 2007 from Indiana do show a retinal pigment epithelial rip, but at that time the vision was 20/50, so it is possible some of the visual loss might be re-treatable. I injected her with Avastin, 1.25 mg/0.05 ml without any difficulty.

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Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)156 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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rperipsmallmali_28129.png
Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)67 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)79 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)57 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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rperipsmallmali_28429.png
Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)56 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)75 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)83 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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rperipsmallmali_28729.png
Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)79 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
00000
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rperipsmallmali_28829.png
Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)76 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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rperipsmallmali_28929.png
Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)45 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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rperipsmallmali_281029.png
Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)61 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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rperipsmallmali_281129.png
Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)52 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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rperipsmallmali_281229.png
Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)71 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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rperipsmallmali_281329.png
Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)84 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
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rperipsmallmali_281429.png
Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)80 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
00000
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rperipsmallmali_281529.jpg
Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)108 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
00000
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rperipsmallmali_281629.jpg
Small Retinal Pigment Epithelial Rip and Poor Vision (20/400)108 views80-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/5080-year-old woman vision in the right eye has substantially declined.
OD: 20/400; OS: 20/50
00000
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80-year-old woman has age-related macular degeneration in both eyes. She was in Indiana over the summer. She noticed since she was last here in March that the vision in the right eye has substantially declined. VISUAL ACUITY: OD: 20/400; OS: 20/50. IOP: OD: 14, OS: 20. The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: C/D ratio is 0.5. There is hyper-pigmentation temporal to the fovea. There is de-pigmentation under the fovea with thickening of the retina centrally. OS: Vertical C/D ratio is 0.5. There are patchy drusen and pigment spots. There is no subretinal fluid, hemorrhage or exudate. The OCT scan of the right eye shows retinal atrophy with edema inferior and temporal to the fovea. The left eye has retinal atrophy overlying thickened pigment epithelium with no intraretinal or subretinal fluid. A fluorescein angiogram of the right eye shows a typical hyperfluorescent spot nasal to the fovea and involving the fovea, characteristic of a retinal pigment epithelial rip. The left eye has some staining macular drusen. The right eye does have hyperfluorescence in the area of the pigment epithelial detachment showing a low-grade occult neovascular membrane. IMPRESSION: 1. WET AGE-RELATED MACULAR DEGENERATION IN THE RIGHT EYE. 2. RETINAL PIGMENT EPITHELIAL RIP IN THE RIGHT EYE. 3. DRY AGE-RELATED MACULAR DEGENERATION IN THE LEFT EYE. 4. MACULAR EDEMA IN THE RIGHT EYE. DISCUSSION: I explained to the patient that the right eye does have, unfortunately, a retinal pigment epithelial rip, which has caused severe central vision loss. She also, in addition to that, has wet age-related macular degeneration and I suggested a treatment with Avastin to dry up the macula and improve the vision. I have had some patients in that situation sometimes benefit from therapy. Her photos from August of 2007 from Indiana do show a retinal pigment epithelial rip, but at that time the vision was 20/50, so it is possible some of the visual loss might be re-treatable. I injected her with Avastin, 1.25 mg/0.05 ml without any difficulty.