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This pleasant 55-year-old man was seen in the office on 6/17/08. He noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. He has been getting along nicely driving. He had a metal injury a long time ago in his right eye that was treated in the emergency room. Surgery was not needed for this injury. He does not have a significant family history of retinal diseases, although most family members do wear glasses. He does smoke cigarettes, but he is going to try to quit. VISUAL ACUITY: Vision OD is 20/100, OS is 20/50. IOP: OD 15, OS 13. Color vision OD 7 out of 10 correction, OS 8 out of 10 correct. AMSLER GRID: Normal OU. SLIT LAMP EXAM: There is 3+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is a posterior vitreous separation with 2+ vitreous cells. There is 2+ cystoid macular edema. There is peripapillary atrophy, chorioretinal scarring, and bone spicules 360° at the equator, touching the macula. OS: Vertical C/D ratio is 0.2. There is a posterior vitreous separation and 2+ macular edema. Again, there is peripapillary atrophy and there are bone spicule pigment irregularities 360° at the equator. OCT SCAN: There is macular thickening in both eyes with intraretinal cysts. FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA shows hyperfluorescence in the periphery 360° around the macula, consistent with retinitis pigmentosa. The fovea has had minimal staining with fluorescein in the late frames. IMPRESSION: 1. POSSIBLE RETINITIS PIGMENTOSA – BOTH EYES 2. POSSIBLE CHORIORETINAL INFLAMMATORY INFECTIOUS CHORIORETINOPATHY – BOTH EYES 3. MACULAR EDEMA – BOTH EYES DISCUSSION: I explained to the patient he does have macular edema in both eyes, limiting his vision. I put him on Xibrom and Econopred drops to see if that will eliminate the macular edema. If it is from retinitis pigmentosa, sometimes Acetazolamide will help. Since he has a new diagnosis of retinitis pigmentosa and since this is atypical in that the symptoms are presenting so late in life, I am going to obtain blood tests to rule out possible infectious or inflammatory etiologies. He does not have any health problems that point to any specific diagnosis except for arthritis. He will return for check in 6-8 weeks, sooner should he notice any problems.

rp_dewo01.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old202 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old106 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo03.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old126 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo04.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old90 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo05.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old88 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo06.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old78 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo07.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old91 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old66 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo09.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old61 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo10.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old59 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo11.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old90 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo12.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old67 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo13.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old86 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo14.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old58 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo15.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old73 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo16.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old40 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo17.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old39 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo18.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old41 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo19.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old62 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo20.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old63 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo21.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old70 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo22.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old78 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo23.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old89 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
00000
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rp_dewo24.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old63 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo25.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old54 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo26.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old41 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo27.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old151 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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rp_dewo28.jpg
Retinitis Pigmentosa Newly Diagnosed 55 Year Old126 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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Retinitis Pigmentosa Newly Diagnosed 55 Year Old159 views55-year-old noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. OD is 20/100, OS is 20/50
OCT SCAN: There is macular thickening in both eyes with intraretinal cysts.
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This pleasant 55-year-old man was seen in the office on 6/17/08. He noticed his vision declining recently, over the last few weeks, particularly in the right eye. He said previous to that the vision was not normal but was pretty good. He has been getting along nicely driving. He had a metal injury a long time ago in his right eye that was treated in the emergency room. Surgery was not needed for this injury. He does not have a significant family history of retinal diseases, although most family members do wear glasses. He does smoke cigarettes, but he is going to try to quit. VISUAL ACUITY: Vision OD is 20/100, OS is 20/50. IOP: OD 15, OS 13. Color vision OD 7 out of 10 correction, OS 8 out of 10 correct. AMSLER GRID: Normal OU. SLIT LAMP EXAM: There is 3+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is a posterior vitreous separation with 2+ vitreous cells. There is 2+ cystoid macular edema. There is peripapillary atrophy, chorioretinal scarring, and bone spicules 360° at the equator, touching the macula. OS: Vertical C/D ratio is 0.2. There is a posterior vitreous separation and 2+ macular edema. Again, there is peripapillary atrophy and there are bone spicule pigment irregularities 360° at the equator. OCT SCAN: There is macular thickening in both eyes with intraretinal cysts. FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA shows hyperfluorescence in the periphery 360° around the macula, consistent with retinitis pigmentosa. The fovea has had minimal staining with fluorescein in the late frames. IMPRESSION: 1. POSSIBLE RETINITIS PIGMENTOSA – BOTH EYES 2. POSSIBLE CHORIORETINAL INFLAMMATORY INFECTIOUS CHORIORETINOPATHY – BOTH EYES 3. MACULAR EDEMA – BOTH EYES DISCUSSION: I explained to the patient he does have macular edema in both eyes, limiting his vision. I put him on Xibrom and Econopred drops to see if that will eliminate the macular edema. If it is from retinitis pigmentosa, sometimes Acetazolamide will help. Since he has a new diagnosis of retinitis pigmentosa and since this is atypical in that the symptoms are presenting so late in life, I am going to obtain blood tests to rule out possible infectious or inflammatory etiologies. He does not have any health problems that point to any specific diagnosis except for arthritis. He will return for check in 6-8 weeks, sooner should he notice any problems.