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78-year-old woman who I saw in the office on July 23, 2009. She had cataract surgery done a little short of a year ago in both eyes. She said previous to that the left eye was her worse eye and then she noticed recently possibly six months or a year ago decreasing vision in the right eye. You saw macular edema and suggest that she come in here for an evaluation. VISUAL ACUITY: OD 20/400, OS 20/40. IOP: OD 15, OS 17. SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.6. There is trace pallor of the optic nerve. There is posterior vitreous separation and 3+ cystoid macular edema with pigment epithelium thickening centrally. OS: Vertical C/D ratio is 0.6. There is trace pallor of the optic nerve. There is posterior vitreous separation and 2+ macular drusen. There is a trace epiretinal membrane. OCT SCAN: The OCT scan of the right eye shows macular edema with thickening of the pigment epithelium. The left eye shows retinal atrophy with persistent vitreoretinal traction. The nerve fiber layer scan shows nerve fiber atrophy of the inferior pole of both eyes. The average nerve fiber layer thickness in the right eye is 95 microns, the left eye has 80 microns and the average inferior nerve fiber layer thickness in the right eye is 82 microns, the left eye has 77 microns, which is below normal. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows a classic subfoveal choroidal neovascular membrane in the right eye 3 disc-diameters across, which has brisk leakage. The left eye shows staining drusen. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. SUBFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE - RIGHT EYE 3. MACULAR EDEMA – RIGHT EYE 4. OPTIC ATROPHY – BOTH EYES CONSISTENT WITH POSSIBLE ATTENTION TO GLAUCOMA DISCUSSION: I explained to the patient she does unfortunately have wet age-related macular degeneration in the right eye with intravitreal Avastin there is a ninety percent chance of improving her vision some and a fifty percent chance of improving her vision a lot. I treated the right 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 and see you back regularly. I asked her to take eye vitamins to protect the left eye, this reduces the risk of vision loss in the fellow eye by almost forty percent. I also suggested that she consider Omega 3 fatty acids with Lutein and Zeaxanthin. She will follow an Amsler grid at home and return urgently should she notice a change in the good eye, either way she will return for a check in one month for reevaluation and probably retreatment in the right eye. She understands this is an ongoing treatment and we can make adjustments as needed over the coming months. VA after 1 year of treat and extend was 20/400. her macular was dry.

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Classic Subfoveal Choroidal Neovascular Membrane - 20/400 Vision - 6 - 12 months old lesion270 views78-year-old woman six months or a year ago decreasing vision in the right eye. OD 20/400. Fluorescein angiography shows a classic subfoveal choroidal neovascular membrane in the right eye 3 disc-diameters across, which has brisk leakage. The left eye shows staining drusen.
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Classic Subfoveal Choroidal Neovascular Membrane - 20/400 Vision - 6 - 12 months old lesion205 views78-year-old woman six months or a year ago decreasing vision in the right eye. OD 20/400. Fluorescein angiography shows a classic subfoveal choroidal neovascular membrane in the right eye 3 disc-diameters across, which has brisk leakage. The left eye shows staining drusen.
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Classic Subfoveal Choroidal Neovascular Membrane - 20/400 Vision - 6 - 12 months old lesion202 views78-year-old woman six months or a year ago decreasing vision in the right eye. OD 20/400. Fluorescein angiography shows a classic subfoveal choroidal neovascular membrane in the right eye 3 disc-diameters across, which has brisk leakage. The left eye shows staining drusen.
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Classic Subfoveal Choroidal Neovascular Membrane - 20/400 Vision - 6 - 12 months old lesion250 views78-year-old woman six months or a year ago decreasing vision in the right eye. OD 20/400. Fluorescein angiography shows a classic subfoveal choroidal neovascular membrane in the right eye 3 disc-diameters across, which has brisk leakage. The left eye shows staining drusen.
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Classic Subfoveal Choroidal Neovascular Membrane - 20/400 Vision - 6 - 12 months old lesion135 views78-year-old woman six months or a year ago decreasing vision in the right eye. OD 20/400. Fluorescein angiography shows a classic subfoveal choroidal neovascular membrane in the right eye 3 disc-diameters across, which has brisk leakage. The left eye shows staining drusen.
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Classic Subfoveal Choroidal Neovascular Membrane - 20/400 Vision - 6 - 12 months old lesion129 views78-year-old woman six months or a year ago decreasing vision in the right eye. OD 20/400. Fluorescein angiography shows a classic subfoveal choroidal neovascular membrane in the right eye 3 disc-diameters across, which has brisk leakage. The left eye shows staining drusen.
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Classic Subfoveal Choroidal Neovascular Membrane - 20/400 Vision - 6 - 12 months old lesion101 views78-year-old woman six months or a year ago decreasing vision in the right eye. OD 20/400. Fluorescein angiography shows a classic subfoveal choroidal neovascular membrane in the right eye 3 disc-diameters across, which has brisk leakage. The left eye shows staining drusen.
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Classic Subfoveal Choroidal Neovascular Membrane - 20/400 Vision - 6 - 12 months old lesion124 views78-year-old woman six months or a year ago decreasing vision in the right eye. OD 20/400. Fluorescein angiography shows a classic subfoveal choroidal neovascular membrane in the right eye 3 disc-diameters across, which has brisk leakage. The left eye shows staining drusen.
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Classic Subfoveal Choroidal Neovascular Membrane - 20/400 Vision - 6 - 12 months old lesion156 views78-year-old woman six months or a year ago decreasing vision in the right eye. OD 20/400. Fluorescein angiography shows a classic subfoveal choroidal neovascular membrane in the right eye 3 disc-diameters across, which has brisk leakage. The left eye shows staining drusen.
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78-year-old woman who I saw in the office on July 23, 2009. She had cataract surgery done a little short of a year ago in both eyes. She said previous to that the left eye was her worse eye and then she noticed recently possibly six months or a year ago decreasing vision in the right eye. You saw macular edema and suggest that she come in here for an evaluation. VISUAL ACUITY: OD 20/400, OS 20/40. IOP: OD 15, OS 17. SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.6. There is trace pallor of the optic nerve. There is posterior vitreous separation and 3+ cystoid macular edema with pigment epithelium thickening centrally. OS: Vertical C/D ratio is 0.6. There is trace pallor of the optic nerve. There is posterior vitreous separation and 2+ macular drusen. There is a trace epiretinal membrane. OCT SCAN: The OCT scan of the right eye shows macular edema with thickening of the pigment epithelium. The left eye shows retinal atrophy with persistent vitreoretinal traction. The nerve fiber layer scan shows nerve fiber atrophy of the inferior pole of both eyes. The average nerve fiber layer thickness in the right eye is 95 microns, the left eye has 80 microns and the average inferior nerve fiber layer thickness in the right eye is 82 microns, the left eye has 77 microns, which is below normal. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows a classic subfoveal choroidal neovascular membrane in the right eye 3 disc-diameters across, which has brisk leakage. The left eye shows staining drusen. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. SUBFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE - RIGHT EYE 3. MACULAR EDEMA – RIGHT EYE 4. OPTIC ATROPHY – BOTH EYES CONSISTENT WITH POSSIBLE ATTENTION TO GLAUCOMA DISCUSSION: I explained to the patient she does unfortunately have wet age-related macular degeneration in the right eye with intravitreal Avastin there is a ninety percent chance of improving her vision some and a fifty percent chance of improving her vision a lot. I treated the right 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 and see you back regularly. I asked her to take eye vitamins to protect the left eye, this reduces the risk of vision loss in the fellow eye by almost forty percent. I also suggested that she consider Omega 3 fatty acids with Lutein and Zeaxanthin. She will follow an Amsler grid at home and return urgently should she notice a change in the good eye, either way she will return for a check in one month for reevaluation and probably retreatment in the right eye. She understands this is an ongoing treatment and we can make adjustments as needed over the coming months. VA after 1 year of treat and extend was 20/400. her macular was dry.