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82-year-old woman has age-related macular degeneration in both eyes. She has Avastin injections in the right eye and with that her vision has been good. Lately I have been treating her about every month or six weeks. The last visit she was here there was a little area in the left eye, which looked like there was some fluid and she returns today for evaluation and treatment of the fellow eye. VISUAL ACUITY: OD 20/25, OS 20/20. IOP: OD 14, OS 10. There is 3+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is posterior vitreous separation and pigment epithelium thickening centrally. OS: Vertical C/D ratio is 0.2. There is posterior vitreous separation and pigment epithelium thickening centrally. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: The fluorescein angiogram focusing on the left eye shows a small patch of hyperfluorescence just inferotemporal to the fovea, which lights up in the early frames. In the later images, there is an area of diffuse hyperfluorescence inferotemporal to the fovea corresponding to an occult subfoveal choroidal neovascular membrane, which looks on the fluorescein angiogram to be about 1 ½ mm2 or roughly a disc area in size. The fluorescein angiogram of the right eye shows an area of hyperfluorescence under the macula, predominately temporal to the macula, which stains, but does not leak in the late frames. INDOCYANINE GREEN ANGIOGRAPHY: The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. In the lates frames on the indocyanine green angiogram in the left eye there is a lacy area of neovascularization with leakage again on the inferotemporal edge of the lesion. The entire area being about 2.87 mm2. The indocyanine green angiogram on the right eye shows staining and some leakage from the neovascular complex, again in the center of the macula being about 2.9 mm2. FUNDUS AUTO FLUORESCENCE: Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease. IMPRESSION: 1. WET AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. PIGMENT EPITHELIAL DETACHMENT – BOTH EYES 3. NEW WET AGE-RELATED MACULAR DEGENERATION – LEFT EYE 4. MACULAR EDEMA – LEFT EYE 5. POLYPOIDAL CHOROIDAL VASCULOPATHY – LEFT EYE 6. RETICULAR MACULAR DISEASE DISCUSSION: I explained to the patient with intravitreal Avastin there is a reasonable chance of maintaining the vision in the left eye. 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 about one month for evaluation and probable simultaneous injection in both eyes with Avastin.

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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy140 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy68 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy94 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy103 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy65 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy51 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy66 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy52 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy - Infrared67 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy - Infrared38 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy - Fundus Autofluorescence93 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy - Fundus Autofluorescence59 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy -67 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy - Indocyanine Green Angiogram67 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy 46 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy49 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy 34 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy 46 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy 48 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy - ICG127 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy - Indocyanine Green Angiogram49 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy - Indocyanine Green Angiogram85 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy - Indocyanine Green Angiogram102 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy42 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy - Indocyanine Green Angiogram51 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy - Indocyanine Green Angiogram50 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy87 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy32 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy37 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy44 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy36 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy80 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy88 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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Reticular Macular Disease - Bilateral Wet Macular Degeneration and Polypoidal Choroidal Vasculopathy122 views82-year-old woman has age-related macular degeneration in both eyes. OD 20/25, OS 20/20.

The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease.
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82-year-old woman has age-related macular degeneration in both eyes. She has Avastin injections in the right eye and with that her vision has been good. Lately I have been treating her about every month or six weeks. The last visit she was here there was a little area in the left eye, which looked like there was some fluid and she returns today for evaluation and treatment of the fellow eye. VISUAL ACUITY: OD 20/25, OS 20/20. IOP: OD 14, OS 10. There is 3+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is posterior vitreous separation and pigment epithelium thickening centrally. OS: Vertical C/D ratio is 0.2. There is posterior vitreous separation and pigment epithelium thickening centrally. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: The fluorescein angiogram focusing on the left eye shows a small patch of hyperfluorescence just inferotemporal to the fovea, which lights up in the early frames. In the later images, there is an area of diffuse hyperfluorescence inferotemporal to the fovea corresponding to an occult subfoveal choroidal neovascular membrane, which looks on the fluorescein angiogram to be about 1 ½ mm2 or roughly a disc area in size. The fluorescein angiogram of the right eye shows an area of hyperfluorescence under the macula, predominately temporal to the macula, which stains, but does not leak in the late frames. INDOCYANINE GREEN ANGIOGRAPHY: The indocyanine green angiogram in the left eye shows very early hyperfluorescence from the lesion adjacent to the fovea, which is consistent with polypoidal choroidal vasculopathy. In the lates frames on the indocyanine green angiogram in the left eye there is a lacy area of neovascularization with leakage again on the inferotemporal edge of the lesion. The entire area being about 2.87 mm2. The indocyanine green angiogram on the right eye shows staining and some leakage from the neovascular complex, again in the center of the macula being about 2.9 mm2. FUNDUS AUTO FLUORESCENCE: Both eyes on the auto fluorescence images and on the indocyanine green angiogram have striking areas of reticular macular disease. IMPRESSION: 1. WET AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. PIGMENT EPITHELIAL DETACHMENT – BOTH EYES 3. NEW WET AGE-RELATED MACULAR DEGENERATION – LEFT EYE 4. MACULAR EDEMA – LEFT EYE 5. POLYPOIDAL CHOROIDAL VASCULOPATHY – LEFT EYE 6. RETICULAR MACULAR DISEASE DISCUSSION: I explained to the patient with intravitreal Avastin there is a reasonable chance of maintaining the vision in the left eye. 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 about one month for evaluation and probable simultaneous injection in both eyes with Avastin.