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79-year-old in the office on March 28, 2008. He has been moving out of the Colonial on East Bay into a smaller house in Palm Harbor, and he has been carrying things for some time. He noticed just about two weeks ago he was having difficulty seeing out of the right eye. When he covered his left eye things were distorted when he looked at Venetian blinds, and also he had a black spot. He noticed that since that black spot came on it is becoming a little less bothersome. His left eye has limited vision from a macular pucker. I saw him for the macular pucker back in 2005. He does take a baby aspirin daily. He takes vitamin supplements, fish oils, and is on prednisone because of some sort of enzyme problem with his muscles. VISUAL ACUITY: OD 20/50, OS 20/50. IOP: OU 17. SLIT LAMP EXAM: The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: C/D ratio is 0.5. There is a posterior vitreous separation. There is a subretinal hemorrhage temporal to the fovea with a pocket of subretinal fluid around it. OS: C/D ratio is 0.5. There is a posterior vitreous separation. There is a 2+ epiretinal membrane. OCT SCAN: The OCT scan of the right eyes a large mass under the retina with accommodating subfoveal fluid. The left eye shows the macular pucker, which is unchanged from the scan of 2005. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: FA shows predominately hypofluorescence from the hemorrhage in the right eye. In the very late frames, there is a little bit of hypofluorescence around it, which would be consistent with irritation of pigment epithelium from blood alone. The left eye has a little bit of staining of the vessels where the macular pucker is and irregularity of the retinal vessels. IMPRESSION: 1. SUBRETINAL HEMORRHAGE – RIGHT EYE 2. MACULAR PUCKER – LEFT EYE 3. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 4. POSSIBLE VALSALVA RETINOPATHY – RIGHT EYE DISCUSSION: I explained to the patient that given his history of recently moving many heavy things and with his blood thinners and supplements, and the absence of any clear choroidal neovascularization, I think this may represent Valsalva retinopathy. I asked him to sleep on his right side, to discontinue the aspirin, vitamins, and supplements for the next month. I also asked him to stop moving heavy things for the next month, and to return for a check urgently should he notice a decline in his vision. Vision declined 2 months later and avastin treatment was started. Patient maintained good vision in eye after 1 year of therapy

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94 views79-year-old two weeks ago he was having difficulty seeing out of the right eye. When he covered his left eye things were distorted OD 20/5000000
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Wet AMD Small New Hemorrhage - Valsalva104 views79-year-old two weeks ago he was having difficulty seeing out of the right eye. When he covered his left eye things were distorted OD 20/5000000
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Wet AMD Small New Hemorrhage - Valsalva99 views79-year-old two weeks ago he was having difficulty seeing out of the right eye. When he covered his left eye things were distorted OD 20/5000000
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Wet AMD Small New Hemorrhage - Valsalva90 views79-year-old two weeks ago he was having difficulty seeing out of the right eye. When he covered his left eye things were distorted OD 20/5000000
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Wet AMD Small New Hemorrhage - Valsalva87 views79-year-old two weeks ago he was having difficulty seeing out of the right eye. When he covered his left eye things were distorted OD 20/5000000
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Wet AMD Small New Hemorrhage - Valsalva71 views79-year-old two weeks ago he was having difficulty seeing out of the right eye. When he covered his left eye things were distorted OD 20/5000000
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Wet AMD Small New Hemorrhage - Valsalva101 views79-year-old two weeks ago he was having difficulty seeing out of the right eye. When he covered his left eye things were distorted OD 20/5000000
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79-year-old in the office on March 28, 2008. He has been moving out of the Colonial on East Bay into a smaller house in Palm Harbor, and he has been carrying things for some time. He noticed just about two weeks ago he was having difficulty seeing out of the right eye. When he covered his left eye things were distorted when he looked at Venetian blinds, and also he had a black spot. He noticed that since that black spot came on it is becoming a little less bothersome. His left eye has limited vision from a macular pucker. I saw him for the macular pucker back in 2005. He does take a baby aspirin daily. He takes vitamin supplements, fish oils, and is on prednisone because of some sort of enzyme problem with his muscles. VISUAL ACUITY: OD 20/50, OS 20/50. IOP: OU 17. SLIT LAMP EXAM: The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: C/D ratio is 0.5. There is a posterior vitreous separation. There is a subretinal hemorrhage temporal to the fovea with a pocket of subretinal fluid around it. OS: C/D ratio is 0.5. There is a posterior vitreous separation. There is a 2+ epiretinal membrane. OCT SCAN: The OCT scan of the right eyes a large mass under the retina with accommodating subfoveal fluid. The left eye shows the macular pucker, which is unchanged from the scan of 2005. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: FA shows predominately hypofluorescence from the hemorrhage in the right eye. In the very late frames, there is a little bit of hypofluorescence around it, which would be consistent with irritation of pigment epithelium from blood alone. The left eye has a little bit of staining of the vessels where the macular pucker is and irregularity of the retinal vessels. IMPRESSION: 1. SUBRETINAL HEMORRHAGE – RIGHT EYE 2. MACULAR PUCKER – LEFT EYE 3. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 4. POSSIBLE VALSALVA RETINOPATHY – RIGHT EYE DISCUSSION: I explained to the patient that given his history of recently moving many heavy things and with his blood thinners and supplements, and the absence of any clear choroidal neovascularization, I think this may represent Valsalva retinopathy. I asked him to sleep on his right side, to discontinue the aspirin, vitamins, and supplements for the next month. I also asked him to stop moving heavy things for the next month, and to return for a check urgently should he notice a decline in his vision. Vision declined 2 months later and avastin treatment was started. Patient maintained good vision in eye after 1 year of therapy