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69-year-old woman who I saw in the office on July 15, 2009. She had cataract surgery done in 2006, first in the left eye and subsequently in the right eye. She had vitreous separations with floaters. She also sees temporal flashing lights. In addition she has an unusual symptom of seeing lights in both eyes, sort of blotchy lights that move around throughout the visual field that are there most of the time. They are not regionalized and they seem to be in both eyes and they are not associated with any sort of visual phenomenon, such as looking at street lights or headlights and they can happen in dim lighting or regular lighting. VISUAL ACUITY: OD 20/50. Pinhole 20/30. OS 20/30. IOP: OD 16, OS 15. Amsler grid is normal in both eyes. SLIT EXAMINATION: The right eye has a posterior chamber intraocular lens is in good position with clear capsular. The left eye has a posterior chamber intraocular lens is in good position with 2+ posterior capsular opacity and an open capsule center. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is a posterior vitreous separation and trace epiretinal membrane. OS: Vertical C/D ratio is 0.5. There is posterior vitreous separation and trace epiretinal membrane. OCT SCAN: The OCT scan were normal as are the photos and fluorescein angiograms. ATYPICAL PHOTOPSIAS DISCUSSION: I explained to the patient that the photopsias she is seeing are atypical and do sound like something that we see occasionally in people who have retinal inflammatory disease, such as multiple evanescent white-dot syndrome or acute zonal occult outer retinopathy. All of those diseases though tend to have transient lights and they also tend to be regionalized. Her case is different in that she has had the lights now for several years and they seem to be diffuse. There are some drugs which will cause retinal toxicity, such as Digitalis that can cause people to see unusual light phenomenon and that tends to be a passing thing and she is not on any medications that to my knowledge cause any retinal toxicities. I suggested, just to be on the safe side she have a neurological evaluation, because occasionally visual symptoms are not from the eye, but from the visual pathways and it is possible that she has chronic irritation of her visual pathways somewhere. If you have not done so, it would be reasonable to obtain a visual field, just to make sure there is not something going on with her visual pathways that might be knocking on her visual field and I told her she does not need to return here unless you or she notes further problems. Thank you for allowing me to participate in her care.

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69 Year Old Woman Normal Fluorescein Angiogram509 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Fluorescein Angiogram437 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Fluorescein Angiogram428 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Fluorescein Angiogram364 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Fluorescein Angiogram325 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Fluorescein Angiogram344 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Fluorescein Angiogram341 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Fluorescein Angiogram302 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Fluorescein Angiogram323 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Fluorescein Angiogram273 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Fundus Photograph516 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Fundus Photograph440 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Red Free435 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal FA330 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal fA366 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal FA338 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal FA386 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal FA342 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal FA283 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal FA307 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal FA318 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal FA322 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal OCT483 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal OCT430 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69 Year Old Woman Normal Fundus Photograph641 views69-year-old woman OD 20/50 - OS 20/30 ATYPICAL PHOTOPSIAS
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69-year-old woman who I saw in the office on July 15, 2009. She had cataract surgery done in 2006, first in the left eye and subsequently in the right eye. She had vitreous separations with floaters. She also sees temporal flashing lights. In addition she has an unusual symptom of seeing lights in both eyes, sort of blotchy lights that move around throughout the visual field that are there most of the time. They are not regionalized and they seem to be in both eyes and they are not associated with any sort of visual phenomenon, such as looking at street lights or headlights and they can happen in dim lighting or regular lighting. VISUAL ACUITY: OD 20/50. Pinhole 20/30. OS 20/30. IOP: OD 16, OS 15. Amsler grid is normal in both eyes. SLIT EXAMINATION: The right eye has a posterior chamber intraocular lens is in good position with clear capsular. The left eye has a posterior chamber intraocular lens is in good position with 2+ posterior capsular opacity and an open capsule center. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is a posterior vitreous separation and trace epiretinal membrane. OS: Vertical C/D ratio is 0.5. There is posterior vitreous separation and trace epiretinal membrane. OCT SCAN: The OCT scan were normal as are the photos and fluorescein angiograms. ATYPICAL PHOTOPSIAS DISCUSSION: I explained to the patient that the photopsias she is seeing are atypical and do sound like something that we see occasionally in people who have retinal inflammatory disease, such as multiple evanescent white-dot syndrome or acute zonal occult outer retinopathy. All of those diseases though tend to have transient lights and they also tend to be regionalized. Her case is different in that she has had the lights now for several years and they seem to be diffuse. There are some drugs which will cause retinal toxicity, such as Digitalis that can cause people to see unusual light phenomenon and that tends to be a passing thing and she is not on any medications that to my knowledge cause any retinal toxicities. I suggested, just to be on the safe side she have a neurological evaluation, because occasionally visual symptoms are not from the eye, but from the visual pathways and it is possible that she has chronic irritation of her visual pathways somewhere. If you have not done so, it would be reasonable to obtain a visual field, just to make sure there is not something going on with her visual pathways that might be knocking on her visual field and I told her she does not need to return here unless you or she notes further problems. Thank you for allowing me to participate in her care.