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decreased vision OS over the past 2 months. She describes a blurred central scotoma. Symptoms have remained stable over the past couple of months. She denies floaters and she denies any visual changes OD. She denies scotoma OD. She denies metamorphopsia OU. PAST OCULAR HISTORY: Significant for cataract extraction with intraocular lens implant OS on 6/27/07. She denies history of laser treatments. Denies ocular trauma. PAST MEDICAL HISTORY: 64-year-old female who has had diabetes for 2 years. She denies a history of retinopathy. Her last blood glucose reading was 97. She also has hypertension, which is under control and hypercholesterolemia. She also has rheumatoid arthritis and is on Plaquenil 200 mg BID for 15 years. She does have yearly visual field tests done with last visual field test performed in 2006, which was within normal limits. She is also on Prevacid, Coreg, Norvasc, Cozaar, Zocor and Prednisone and Actonel. FAMILY HISTORY: Negative for ocular disease. SOCIAL HISTORY: Denies tobacco or alcohol use. REVIEW OF SYSTEMS: Listed on chart. OCULAR EXAMINATION: Visual acuity with correction OD 20/40-2, PHNI, J7 at near. OS 20/40-1, J7 at near. She is ortho with full versions and fields. No relative afferent pupillary defect. Amsler grid normal OU. There is no evidence of scotoma OU. Color vision 0/10 OD, 1/10 OS. tension 12 OD, 11 OS. ANTERIOR SEGMENT EXAMINATION: Lids and lashes are unremarkable. Conjunctiva and sclera are quiet. Corneas are clear. Anterior chambers are deep and quiet. Irides are unremarkable. Pupils are well dilated and round. There is no rubeosis. Right lens with 2+ nuclear sclerosis. Left PC IOL is in stable centered position with clear intact posterior capsule. Anterior vitreous is quiet with liquefaction. POSTERIOR SEGMENT EXAMINATION: Optic nerves are pink with 0.3 cupping OD, 0.25 cupping OS. I see no optic disc edema, notching, pallor or hemorrhage. Posterior vitreous detachments are seen in both eyes. Major vessels are patent. Central macula of right eye shows subtle RPE changes with pigment clumping and a ring of atrophy surrounding the central fovea consistent with bulls eye maculopathy. More subtle changes are seen in the left eye with mild RPE changes. There is a few scattered drusen peripherally. I see no obvious central macular exudation. No cystic changes particularly in the left eye. Peripherally retinas are attached and stable. I see no evidence of diabetic microangiopathy. OCT concentrating on both eyes shows central macular thinning at 163 microns OD and 147 microns OS. I see no evidence of intraretinal or subretinal fluid. No evidence of preretinal traction. FLUORESCEIN ANGIOGRAM: FA concentrating on both eyes shows early transmission hyper fluorescence surrounding the central fovea with a more prominent bulls eye pattern of transmission hyper fluorescence around the central fovea of the left eye. On progressive phases, there is no evidence of macular leakage of fluorescein. IMPRESSION: 1. BULLS EYE MACULOPATHY OU SECONDARY TO CHRONIC PLAQUENIL USE.

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Plaquenil Toxicity with New Symptomatic Scotoma Left Eye278 views64-year-old female decreased vision OS over the past 2 months. She describes a blurred central scotoma. She has rheumatoid arthritis and is on Plaquenil 200 mg BID for 15 years. She does have yearly visual field tests done with last visual field test performed 3 years ago which was within normal limits OD 20/40-2 OS 20/40-100000
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Plaquenil Toxicity with New Symptomatic Scotoma Left Eye131 views64-year-old female decreased vision OS over the past 2 months. She describes a blurred central scotoma. She has rheumatoid arthritis and is on Plaquenil 200 mg BID for 15 years. She does have yearly visual field tests done with last visual field test performed 3 years ago which was within normal limits OD 20/40-2 OS 20/40-100000
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Plaquenil Toxicity with New Symptomatic Scotoma Left Eye191 views64-year-old female decreased vision OS over the past 2 months. She describes a blurred central scotoma. She has rheumatoid arthritis and is on Plaquenil 200 mg BID for 15 years. She does have yearly visual field tests done with last visual field test performed 3 years ago which was within normal limits OD 20/40-2 OS 20/40-100000
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Plaquenil Toxicity with New Symptomatic Scotoma Left Eye189 views64-year-old female decreased vision OS over the past 2 months. She describes a blurred central scotoma. She has rheumatoid arthritis and is on Plaquenil 200 mg BID for 15 years. She does have yearly visual field tests done with last visual field test performed 3 years ago which was within normal limits OD 20/40-2 OS 20/40-100000
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Plaquenil Toxicity with New Symptomatic Scotoma Left Eye298 views64-year-old female decreased vision OS over the past 2 months. She describes a blurred central scotoma. She has rheumatoid arthritis and is on Plaquenil 200 mg BID for 15 years. She does have yearly visual field tests done with last visual field test performed 3 years ago which was within normal limits OD 20/40-2 OS 20/40-100000
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Plaquenil Toxicity with New Symptomatic Scotoma Left Eye181 views64-year-old female decreased vision OS over the past 2 months. She describes a blurred central scotoma. She has rheumatoid arthritis and is on Plaquenil 200 mg BID for 15 years. She does have yearly visual field tests done with last visual field test performed 3 years ago which was within normal limits OD 20/40-2 OS 20/40-100000
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Plaquenil Toxicity with New Symptomatic Scotoma Left Eye163 views64-year-old female decreased vision OS over the past 2 months. She describes a blurred central scotoma. She has rheumatoid arthritis and is on Plaquenil 200 mg BID for 15 years. She does have yearly visual field tests done with last visual field test performed 3 years ago which was within normal limits OD 20/40-2 OS 20/40-100000
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Plaquenil Toxicity with New Symptomatic Scotoma Left Eye165 views64-year-old female decreased vision OS over the past 2 months. She describes a blurred central scotoma. She has rheumatoid arthritis and is on Plaquenil 200 mg BID for 15 years. She does have yearly visual field tests done with last visual field test performed 3 years ago which was within normal limits OD 20/40-2 OS 20/40-100000
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decreased vision OS over the past 2 months. She describes a blurred central scotoma. Symptoms have remained stable over the past couple of months. She denies floaters and she denies any visual changes OD. She denies scotoma OD. She denies metamorphopsia OU. PAST OCULAR HISTORY: Significant for cataract extraction with intraocular lens implant OS on 6/27/07. She denies history of laser treatments. Denies ocular trauma. PAST MEDICAL HISTORY: 64-year-old female who has had diabetes for 2 years. She denies a history of retinopathy. Her last blood glucose reading was 97. She also has hypertension, which is under control and hypercholesterolemia. She also has rheumatoid arthritis and is on Plaquenil 200 mg BID for 15 years. She does have yearly visual field tests done with last visual field test performed in 2006, which was within normal limits. She is also on Prevacid, Coreg, Norvasc, Cozaar, Zocor and Prednisone and Actonel. FAMILY HISTORY: Negative for ocular disease. SOCIAL HISTORY: Denies tobacco or alcohol use. REVIEW OF SYSTEMS: Listed on chart. OCULAR EXAMINATION: Visual acuity with correction OD 20/40-2, PHNI, J7 at near. OS 20/40-1, J7 at near. She is ortho with full versions and fields. No relative afferent pupillary defect. Amsler grid normal OU. There is no evidence of scotoma OU. Color vision 0/10 OD, 1/10 OS. tension 12 OD, 11 OS. ANTERIOR SEGMENT EXAMINATION: Lids and lashes are unremarkable. Conjunctiva and sclera are quiet. Corneas are clear. Anterior chambers are deep and quiet. Irides are unremarkable. Pupils are well dilated and round. There is no rubeosis. Right lens with 2+ nuclear sclerosis. Left PC IOL is in stable centered position with clear intact posterior capsule. Anterior vitreous is quiet with liquefaction. POSTERIOR SEGMENT EXAMINATION: Optic nerves are pink with 0.3 cupping OD, 0.25 cupping OS. I see no optic disc edema, notching, pallor or hemorrhage. Posterior vitreous detachments are seen in both eyes. Major vessels are patent. Central macula of right eye shows subtle RPE changes with pigment clumping and a ring of atrophy surrounding the central fovea consistent with bulls eye maculopathy. More subtle changes are seen in the left eye with mild RPE changes. There is a few scattered drusen peripherally. I see no obvious central macular exudation. No cystic changes particularly in the left eye. Peripherally retinas are attached and stable. I see no evidence of diabetic microangiopathy. OCT concentrating on both eyes shows central macular thinning at 163 microns OD and 147 microns OS. I see no evidence of intraretinal or subretinal fluid. No evidence of preretinal traction. FLUORESCEIN ANGIOGRAM: FA concentrating on both eyes shows early transmission hyper fluorescence surrounding the central fovea with a more prominent bulls eye pattern of transmission hyper fluorescence around the central fovea of the left eye. On progressive phases, there is no evidence of macular leakage of fluorescein. IMPRESSION: 1. BULLS EYE MACULOPATHY OU SECONDARY TO CHRONIC PLAQUENIL USE.