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71-year-old woman was seen in the office on 10/25/2011. She was last seen here in June of 2006. She had a scotoma superiorly with a visual field defect at the time. You recently noticed a new Hollenhorst plaque off the superonasal branch arteriole in the right eye and suggested she come back here for an evaluation. She is not noticing any vision change. She does take pressure-lowering drops for glaucoma, both Timolol and Xalatan. VISUAL ACUITY: Vision OD is 20/30, OS is 20/16. IOP: OD 15, OS 17. Color vision is normal. SLIT LAMP EXAM: There is 3+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. There is an intra-arterial plaque just prior to a bifurcation along the superotemporal branch retinal arteriole. The macula looks normal. OS: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. The macula and periphery look healthy. OCT SCAN: The OCT scan in the right eye does show dense atrophy of the superficial retinal layers in the inferior half of the macula showing a previous inferotemporal macular branch retinal artery occlusion. The left eye has a normal macular scan. The nerve fiber layer scans are similarly normal with the average thickness in the right eye 99 microns and the left eye 100 microns. IMPRESSION: 1. OLD BRANCH RETINAL ARTERY OCCLUSION INFEROTEMPORALLY – RIGHT EYE 2. NEW SUPERONASAL HOLLENHORST PLAQUE – RIGHT EYE 3. CATARACTS – BOTH EYES 4. HISTORY OF CAROTID DISEASE 5. GLAUCOMA DISCUSSION: I explained to the patient that the plaque in the right eye is an area which is not visually threatening. She is already having her carotids evaluated. She had surgery some time ago and recently had repeat ultrasounds.

hollenhorst_bowa01.jpg
Asymptomatic Hollenhorst Plaque - Cholesterol Embolis417 views71-year-old woman is not noticing any vision change. She does take pressure-lowering drops for glaucoma, both Timolol and Xalatan.

VISUAL ACUITY: Vision OD is 20/30, OS is 20/16
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hollenhorst_bowa02.jpg
Asymptomatic Hollenhorst Plaque - Cholesterol Embolis474 views71-year-old woman is not noticing any vision change. She does take pressure-lowering drops for glaucoma, both Timolol and Xalatan.

VISUAL ACUITY: Vision OD is 20/30, OS is 20/16
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hollenhorst_bowa03.jpg
Asymptomatic Hollenhorst Plaque - Cholesterol Embolis505 views71-year-old woman is not noticing any vision change. She does take pressure-lowering drops for glaucoma, both Timolol and Xalatan.

VISUAL ACUITY: Vision OD is 20/30, OS is 20/16
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71-year-old woman was seen in the office on 10/25/2011. She was last seen here in June of 2006. She had a scotoma superiorly with a visual field defect at the time. You recently noticed a new Hollenhorst plaque off the superonasal branch arteriole in the right eye and suggested she come back here for an evaluation. She is not noticing any vision change. She does take pressure-lowering drops for glaucoma, both Timolol and Xalatan. VISUAL ACUITY: Vision OD is 20/30, OS is 20/16. IOP: OD 15, OS 17. Color vision is normal. SLIT LAMP EXAM: There is 3+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. There is an intra-arterial plaque just prior to a bifurcation along the superotemporal branch retinal arteriole. The macula looks normal. OS: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. The macula and periphery look healthy. OCT SCAN: The OCT scan in the right eye does show dense atrophy of the superficial retinal layers in the inferior half of the macula showing a previous inferotemporal macular branch retinal artery occlusion. The left eye has a normal macular scan. The nerve fiber layer scans are similarly normal with the average thickness in the right eye 99 microns and the left eye 100 microns. IMPRESSION: 1. OLD BRANCH RETINAL ARTERY OCCLUSION INFEROTEMPORALLY – RIGHT EYE 2. NEW SUPERONASAL HOLLENHORST PLAQUE – RIGHT EYE 3. CATARACTS – BOTH EYES 4. HISTORY OF CAROTID DISEASE 5. GLAUCOMA DISCUSSION: I explained to the patient that the plaque in the right eye is an area which is not visually threatening. She is already having her carotids evaluated. She had surgery some time ago and recently had repeat ultrasounds.