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82-year-old man was seen in the office on May 31, 2012. He had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. VISUAL ACUITY: OD 20/25, OS 20/20. IOP: 15 OU. SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is posterior vitreous separation and reticular drusen. There is edema temporal to the fovea. There is no hemorrhage though. OS: Vertical C/D ratio is 0.5. There is posterior vitreous separation and reticular drusen. SPECTRALIS-SD-OCT SCAN: The OCT scan shows cystoid macular edema in the right eye and reticular pseudo drusen in both eyes. IMPRESSION: 1. CYSTOID MACULAR EDEMA – RIGHT EYE 2. MACULAR DEGENERATION – BOTH EYES 3. RETICULAR MACULAR DISEASE IN BOTH EYES 4. GLAUCOMA WITH LUMIGAN THERAPY DISCUSSION: I explained to the patient I don’t see any sign of wet age-related macular degeneration in the right eye. Given that his cataract surgery was so long ago, I don’t think this could be pseudophakic cystoid macular edema. It is possible that it might be Lumigan induced macular edema and I asked him to stop the Lumigan, and to return in a month. 1 Month Later: 82-year-old man has cystoid macular edema in the right eye, probably associated with his Lumigan. He stopped the drop May 31st when I saw him and his vision is better. In fact it is better than the left eye. VISUAL ACUITY: OD 20/20, OS 20/25. IOP: 12 OU. The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is 1+ macular drusen. SPECTRALIS-SD-OCT SCAN: The OCT scan shows decreased macular edema in the right eye. The average central foveal thickness is 350 microns. (NOTE: Retinal thickness measured with Spectralis OCT is approximately 70 μm greater than that measured with Stratus OCT. This increased measurement corresponds to the inclusion of the outer segment-RPE-Bruch's membrane complex by Spectralis OCT.) IMPRESSION: 1. LUMIGAN INDUCED CYSTOID MACULAR EDEMA – RIGHT EYE DISCUSSION: I explained to the patient that the macula in the right eye is dried up now that he is off the Lumigan. I asked to continue the Lumigan in the left eye. He does notice the left eye is a little worse than the right eye. I suggest he see you back in about two months and I would recommend checking both eyes on that visit to make sure the left macula is not developing a similar problem. In the meantime the pressure of twelve in the right eye is reasonable and I think he probably could continue without any pressure lowering therapy, at least for now. VISUAL ACUITY: OD 20/25, OS 20/20. IOP: 15 OU. SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is posterior vitreous separation and reticular drusen. There is edema temporal to the fovea. There is no hemorrhage though. OS: Vertical C/D ratio is 0.5. There is posterior vitreous separation and reticular drusen. SPECTRALIS-SD-OCT SCAN: The OCT scan shows cystoid macular edema in the right eye and reticular pseudo drusen in both eyes. FUNDUS PHOTOGRAPHY - INFRA RED: The image shows reticular pseudo drusen in both eyes. FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: The image was normal in both eyes. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows cystoid staining of the macula in the late frame in the right eye with staining of the macular drusen. The left eye shows staining of the macular drusen. The optic nerves don’t appear to be differentially staining in the two eyes. IMPRESSION: 1. CYSTOID MACULAR EDEMA – RIGHT EYE 2. MACULAR DEGENERATION – BOTH EYES 3. RETICULAR MACULAR DISEASE IN BOTH EYES 4. GLAUCOMA WITH LUMIGAN THERAPY DISCUSSION: I explained to the patient I don’t see any sign of wet age-related macular degeneration in the right eye. Given that his cataract surgery was so long ago, I don’t think this could be pseudophakic cystoid macular edema. It is possible that it might be Lumigan induced macular edema and I asked him to stop the Lumigan, and to return in a month.

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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan172 views00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan56 views00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan67 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan67 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan52 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan42 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan59 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan44 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan61 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan38 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan48 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan41 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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57 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping LumiganLumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan63 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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60 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan40 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan49 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan42 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan26 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan40 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan44 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan46 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan37 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan54 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan122 views 82-year-old man had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. Vision 20/25 OD, 20/20 OS00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan118 viewsVision back to 20/20 1 month after stopping Lumigan00000
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Lumigan (Bimatoprost) Cystoid Macular Edema - Eye Better 1 month after Stopping Lumigan154 viewsVision back to 20/20 1 month after stopping Lumigan00000
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82-year-old man was seen in the office on May 31, 2012. He had cataract surgery in 1993. He has had glaucoma for seven or eight years for a long time. He is taking Lumigan only in the left eye. About a year ago he started in the right eye and then starting just about a few months ago he has noticed intermittent blurring in the vision in the right eye. VISUAL ACUITY: OD 20/25, OS 20/20. IOP: 15 OU. SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is posterior vitreous separation and reticular drusen. There is edema temporal to the fovea. There is no hemorrhage though. OS: Vertical C/D ratio is 0.5. There is posterior vitreous separation and reticular drusen. SPECTRALIS-SD-OCT SCAN: The OCT scan shows cystoid macular edema in the right eye and reticular pseudo drusen in both eyes. IMPRESSION: 1. CYSTOID MACULAR EDEMA – RIGHT EYE 2. MACULAR DEGENERATION – BOTH EYES 3. RETICULAR MACULAR DISEASE IN BOTH EYES 4. GLAUCOMA WITH LUMIGAN THERAPY DISCUSSION: I explained to the patient I don’t see any sign of wet age-related macular degeneration in the right eye. Given that his cataract surgery was so long ago, I don’t think this could be pseudophakic cystoid macular edema. It is possible that it might be Lumigan induced macular edema and I asked him to stop the Lumigan, and to return in a month. 1 Month Later: 82-year-old man has cystoid macular edema in the right eye, probably associated with his Lumigan. He stopped the drop May 31st when I saw him and his vision is better. In fact it is better than the left eye. VISUAL ACUITY: OD 20/20, OS 20/25. IOP: 12 OU. The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is 1+ macular drusen. SPECTRALIS-SD-OCT SCAN: The OCT scan shows decreased macular edema in the right eye. The average central foveal thickness is 350 microns. (NOTE: Retinal thickness measured with Spectralis OCT is approximately 70 μm greater than that measured with Stratus OCT. This increased measurement corresponds to the inclusion of the outer segment-RPE-Bruch's membrane complex by Spectralis OCT.) IMPRESSION: 1. LUMIGAN INDUCED CYSTOID MACULAR EDEMA – RIGHT EYE DISCUSSION: I explained to the patient that the macula in the right eye is dried up now that he is off the Lumigan. I asked to continue the Lumigan in the left eye. He does notice the left eye is a little worse than the right eye. I suggest he see you back in about two months and I would recommend checking both eyes on that visit to make sure the left macula is not developing a similar problem. In the meantime the pressure of twelve in the right eye is reasonable and I think he probably could continue without any pressure lowering therapy, at least for now. VISUAL ACUITY: OD 20/25, OS 20/20. IOP: 15 OU. SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is posterior vitreous separation and reticular drusen. There is edema temporal to the fovea. There is no hemorrhage though. OS: Vertical C/D ratio is 0.5. There is posterior vitreous separation and reticular drusen. SPECTRALIS-SD-OCT SCAN: The OCT scan shows cystoid macular edema in the right eye and reticular pseudo drusen in both eyes. FUNDUS PHOTOGRAPHY - INFRA RED: The image shows reticular pseudo drusen in both eyes. FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: The image was normal in both eyes. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows cystoid staining of the macula in the late frame in the right eye with staining of the macular drusen. The left eye shows staining of the macular drusen. The optic nerves don’t appear to be differentially staining in the two eyes. IMPRESSION: 1. CYSTOID MACULAR EDEMA – RIGHT EYE 2. MACULAR DEGENERATION – BOTH EYES 3. RETICULAR MACULAR DISEASE IN BOTH EYES 4. GLAUCOMA WITH LUMIGAN THERAPY DISCUSSION: I explained to the patient I don’t see any sign of wet age-related macular degeneration in the right eye. Given that his cataract surgery was so long ago, I don’t think this could be pseudophakic cystoid macular edema. It is possible that it might be Lumigan induced macular edema and I asked him to stop the Lumigan, and to return in a month.