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88-year-old woman who I saw in the office on April 22, 2009. She is on Coumadin for a history of blood clots. She has had advanced age-related macular degeneration for many years. She uses a reading machine for about the last five years to read. She sees you about every three to six months for comprehensive evaluations and then during the most recent evaluation, you noticed a hemorrhage in the retina in the right eye, which is her better eye and you suggested that she come in here for an evaluation because of that. She does also complain of one other visual symptom where she looks at the clock by her bed at night time, which she thinks is probably a greenish or purplish light. She sees multiple images, but during the day she does not see multiple images. VISUAL ACUITY: OD 20/400, OS 8/200. IOP: OD 9, OS 11. 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 posterior vitreous separation. There is a well-circumscribed area of concentric geographic atrophy involving the center of the macula and the fovea. There are flame hemorrhages inferior to the macula along the inferotemporal branch retinal vein. OS: Vertical C/D ratio is 0.5. There is a well-circumscribed area of geographic atrophy centrally. There is no intraretinal or subretinal fluid. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows hyperfluorescence corresponding to the hemorrhage inferiorly in the right eye, some of which is in front of a blood vessel, suggesting that it is a flame hemorrhage, not age-related macular degeneration. Both eyes have hyperfluorescence centrally from the broad areas of geographic atrophy. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. GEOGRAPHIC ATROPHY – BOTH EYES 3. FLAME RETINAL HEMORRHAGE – RIGHT EYE 4. WARAFIN THERAPY DISCUSSION: I explained to the patient that the hemorrhage in the right eye is superficial and benign and not associated with her age-related macular degeneration. I suspect it will reabsorb over the next few months.

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Geographic Atophy Both Eyes - New Bleed Right Eye115 views88-year-old woman on Coumadin for a history of blood clots new hemorrhage in the retina in the right eye, which is her better eye - Geographic Atrophy OU 20/400 OU00000
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Geographic Atophy Both Eyes - New Bleed Right Eye102 views88-year-old woman on Coumadin for a history of blood clots new hemorrhage in the retina in the right eye, which is her better eye - Geographic Atrophy OU 20/400 OU00000
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Geographic Atophy Both Eyes - New Bleed Right Eye131 views88-year-old woman on Coumadin for a history of blood clots new hemorrhage in the retina in the right eye, which is her better eye - Geographic Atrophy OU 20/400 OU00000
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Geographic Atophy Both Eyes - New Bleed Right Eye108 views88-year-old woman on Coumadin for a history of blood clots new hemorrhage in the retina in the right eye, which is her better eye - Geographic Atrophy OU 20/400 OU00000
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Geographic Atophy Both Eyes - New Bleed Right Eye106 views88-year-old woman on Coumadin for a history of blood clots new hemorrhage in the retina in the right eye, which is her better eye - Geographic Atrophy OU 20/400 OU00000
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Geographic Atophy Both Eyes - New Bleed Right Eye47 views88-year-old woman on Coumadin for a history of blood clots new hemorrhage in the retina in the right eye, which is her better eye - Geographic Atrophy OU 20/400 OU00000
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Geographic Atophy Both Eyes - New Bleed Right Eye73 views88-year-old woman on Coumadin for a history of blood clots new hemorrhage in the retina in the right eye, which is her better eye - Geographic Atrophy OU 20/400 OU00000
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Geographic Atophy Both Eyes - New Bleed Right Eye57 views88-year-old woman on Coumadin for a history of blood clots new hemorrhage in the retina in the right eye, which is her better eye - Geographic Atrophy OU 20/400 OU00000
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Geographic Atophy Both Eyes - New Bleed Right Eye69 views88-year-old woman on Coumadin for a history of blood clots new hemorrhage in the retina in the right eye, which is her better eye - Geographic Atrophy OU 20/400 OU00000
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Geographic Atophy Both Eyes - New Bleed Right Eye45 views88-year-old woman on Coumadin for a history of blood clots new hemorrhage in the retina in the right eye, which is her better eye - Geographic Atrophy OU 20/400 OU00000
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Geographic Atophy Both Eyes - New Bleed Right Eye77 views88-year-old woman on Coumadin for a history of blood clots new hemorrhage in the retina in the right eye, which is her better eye - Geographic Atrophy OU 20/400 OU00000
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88-year-old woman who I saw in the office on April 22, 2009. She is on Coumadin for a history of blood clots. She has had advanced age-related macular degeneration for many years. She uses a reading machine for about the last five years to read. She sees you about every three to six months for comprehensive evaluations and then during the most recent evaluation, you noticed a hemorrhage in the retina in the right eye, which is her better eye and you suggested that she come in here for an evaluation because of that. She does also complain of one other visual symptom where she looks at the clock by her bed at night time, which she thinks is probably a greenish or purplish light. She sees multiple images, but during the day she does not see multiple images. VISUAL ACUITY: OD 20/400, OS 8/200. IOP: OD 9, OS 11. 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 posterior vitreous separation. There is a well-circumscribed area of concentric geographic atrophy involving the center of the macula and the fovea. There are flame hemorrhages inferior to the macula along the inferotemporal branch retinal vein. OS: Vertical C/D ratio is 0.5. There is a well-circumscribed area of geographic atrophy centrally. There is no intraretinal or subretinal fluid. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows hyperfluorescence corresponding to the hemorrhage inferiorly in the right eye, some of which is in front of a blood vessel, suggesting that it is a flame hemorrhage, not age-related macular degeneration. Both eyes have hyperfluorescence centrally from the broad areas of geographic atrophy. IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES 2. GEOGRAPHIC ATROPHY – BOTH EYES 3. FLAME RETINAL HEMORRHAGE – RIGHT EYE 4. WARAFIN THERAPY DISCUSSION: I explained to the patient that the hemorrhage in the right eye is superficial and benign and not associated with her age-related macular degeneration. I suspect it will reabsorb over the next few months.