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58-year-old woman was seen in the office on June 30, 2011. When she was very young her vision never corrected to 20/20 and then in 1982 she was fitted for gas permeable contact lenses and she was able to see well enough to drive. She saw well until around 2002, at which point the lenses were no longer affective and she had a clear lens exchange , at which point her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. She possibly attributed it to different medication she was taking, but since it is no better she comes in for an evaluation. She does take fish oil as well as other medications. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16. IOP: OD 13, OS 12. SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes with open capsules. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is peripapillary atrophy. There is a posterior staphyloma. There is lattice degeneration inferotemporally peripherally. OS: Vertical C/D ratio is 0.1. There is peripapillary atrophy. There is a posterior staphyloma. There is lattice degeneration inferotemporally. OCT SCAN: The OCT scan shows stretching of the photoreceptors in both eyes consistent with myopic tractional maculopathy with non foveal retinal detachments, worse in the left eye than the right eye. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows hyperfluorescence corresponding to the areas of atrophy. There is no clear evidence of any neovascularization in either eye. IMPRESSION: 1. RETINAL DETACHMENTS – WORSE IN THE LEFT EYE THAN THE RIGHT EYE 2. VISION LOSS – LEFT EYE 3. POSSIBLE MYOPIC TRACTIONAL MACULOPATHY 4. POSSIBLE OCCULT SUBRETINAL CHOROIDAL NEOVASCULAR MEMBRANE – LEFT EYE DISCUSSION: I explained to the patient with subretinal fluid in the left eye and the vision loss, the most likely explanation is an occult subretinal choroidal neovascular membrane associated with her high myopia and the treatment for that would be intravitreal injections, which are relatively low risk. It is also possible she has myopic tractional maculopathy, which is less common and treatment for that is a vitrectomy. The treatment for the more common disease is safer, I suggest we try a series of three Avastin treatments to see if that will improve the vision and induce absorption of subretinal fluid. I treated the left eye with intravitreal injection of Avastin (1.25 mg/0.05 ml) without any difficulty today. I asked her to return for a check in one month or sooner should she notice a problem. After three treatments she is no better, I will probably consider a vitrectomy with a gas bubble in that eye.

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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane291 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane173 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane114 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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myopicdegen_chce04.png
Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane131 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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myopicdegen_chce05.png
Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane143 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane219 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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myopicdegen_chce07.png
Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane112 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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myopicdegen_chce08.png
Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane124 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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myopicdegen_chce09.png
Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane79 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane84 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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myopicdegen_chce11.png
Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane87 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane76 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane54 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane56 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane92 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane73 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane74 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane91 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane134 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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myopictraction_chce02.jpg
Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane132 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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myopictraction_chce03.jpg
Myopic Traction Maculopathy - Vitreoretinal Traction - Possible Occult Neovascular Membrane172 x angesehen58-year-old woman was seen in the office on June 30, 2011. In 2002, her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16.00000
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58-year-old woman was seen in the office on June 30, 2011. When she was very young her vision never corrected to 20/20 and then in 1982 she was fitted for gas permeable contact lenses and she was able to see well enough to drive. She saw well until around 2002, at which point the lenses were no longer affective and she had a clear lens exchange , at which point her vision was 20/30. Subsequent to that she had her left eye made her distance eye, which was dominate. She had LASIK surgery on the right eye to make that her near eye and she was getting along well until about a year ago when she noticed substantial vision loss in the left eye only. She possibly attributed it to different medication she was taking, but since it is no better she comes in for an evaluation. She does take fish oil as well as other medications. VISUAL ACUITY: The near eye is 20/200, but she reads J2. OS 20/100- and J16. IOP: OD 13, OS 12. SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes with open capsules. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is peripapillary atrophy. There is a posterior staphyloma. There is lattice degeneration inferotemporally peripherally. OS: Vertical C/D ratio is 0.1. There is peripapillary atrophy. There is a posterior staphyloma. There is lattice degeneration inferotemporally. OCT SCAN: The OCT scan shows stretching of the photoreceptors in both eyes consistent with myopic tractional maculopathy with non foveal retinal detachments, worse in the left eye than the right eye. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows hyperfluorescence corresponding to the areas of atrophy. There is no clear evidence of any neovascularization in either eye. IMPRESSION: 1. RETINAL DETACHMENTS – WORSE IN THE LEFT EYE THAN THE RIGHT EYE 2. VISION LOSS – LEFT EYE 3. POSSIBLE MYOPIC TRACTIONAL MACULOPATHY 4. POSSIBLE OCCULT SUBRETINAL CHOROIDAL NEOVASCULAR MEMBRANE – LEFT EYE DISCUSSION: I explained to the patient with subretinal fluid in the left eye and the vision loss, the most likely explanation is an occult subretinal choroidal neovascular membrane associated with her high myopia and the treatment for that would be intravitreal injections, which are relatively low risk. It is also possible she has myopic tractional maculopathy, which is less common and treatment for that is a vitrectomy. The treatment for the more common disease is safer, I suggest we try a series of three Avastin treatments to see if that will improve the vision and induce absorption of subretinal fluid. I treated the left eye with intravitreal injection of Avastin (1.25 mg/0.05 ml) without any difficulty today. I asked her to return for a check in one month or sooner should she notice a problem. After three treatments she is no better, I will probably consider a vitrectomy with a gas bubble in that eye.