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54-year-old woman has had problems in her vision in the right eye for about the last three months. I saw her in May and everything looked okay. She comes back today noting for the last few weeks a substantial change in the paracentral vision in the right eye. Inferotemporally she sees a gray area, which is distorted. She did have a severe coughing problem where she had to take off work for four days when this came on. Her vision in the left eye is fine. VISUAL ACUITY: Vision OD is 20/20, OS is 20/20. IOP: OD 14. The right eye has 1+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. There are patchy pigment irregularities in the macula. Superonasal to the fovea there is a well-circumscribed area of thickening of the pigment epithelium, which is hyperpigmented with a donut-shaped hemorrhage around the edge of it, extending about 100 microns off the side of the scar. The entire complex is about a disc diameter in size and is about a disc diameter away from the central fovea. OCT SCAN: There is edema superonasal to the fovea in the area of the hemorrhage. FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA shows a classic extrafoveal choroidal neovascular membrane with hemorrhage around the edge of it. IMPRESSION: 1. WET AGE-RELATED MACULAR DEGENERATION – RIGHT EYE 2. MYOPIC MACULAR DEGENERATION – RIGHT EYE 3. HEMORRHAGIC PIGMENT EPITHELIAL DETACHMENT – RIGHT EYE DISCUSSION: I explained to the patient with the new onset of bleeding in the right eye from the choroidal neovascular membrane, it is reasonable to consider treatment with intravitreal Avastin or Lucentis. Either treatments include choroidal laser and photodynamic laser, both of which might be helpful in this case but could leave scarring blind spots. At this moment, the standard of care is switched to the injectable treatments because of the low-risk. The office visit included a 15-minute counseling session during which I reviewed the alternatives, risks, benefits and limitations of various treatment options. I injected the eye with Avastin (1.25 mg/0.05 ml) without any difficulty. I asked her to return for check in one month, sooner should she notice any problem. She understands this is an ongoing therapy and she will need treatments at least for awhile. She will return urgently should she notice any problem. She will see you back regularly. Treatment was done for about 9 months with a total of 6 shots and then stopped with no recurrence for one year.

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Myopic Choroidal Neovascular Membrane 54 year old woman 20/20391 views54-year-old woman has had problems in her vision in the right eye for about the last three months. Inferotemporally she sees a gray area, which is distorted. OD is 20/20, OS is 20/2000000
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myopicwetcoki_28129.jpg
Myopic Choroidal Neovascular Membrane 54 year old woman 20/20221 views54-year-old woman has had problems in her vision in the right eye for about the last three months. Inferotemporally she sees a gray area, which is distorted. OD is 20/20, OS is 20/2000000
(0 votes)
myopicwetcoki_28229.jpg
Myopic Choroidal Neovascular Membrane 54 year old woman 20/20302 views54-year-old woman has had problems in her vision in the right eye for about the last three months. Inferotemporally she sees a gray area, which is distorted. OD is 20/20, OS is 20/2000000
(0 votes)
myopicwetcoki_28329.jpg
Myopic Choroidal Neovascular Membrane 54 year old woman 20/20176 views54-year-old woman has had problems in her vision in the right eye for about the last three months. Inferotemporally she sees a gray area, which is distorted. OD is 20/20, OS is 20/2000000
(0 votes)
myopicwetcoki_28429.jpg
Myopic Choroidal Neovascular Membrane 54 year old woman 20/20203 views54-year-old woman has had problems in her vision in the right eye for about the last three months. Inferotemporally she sees a gray area, which is distorted. OD is 20/20, OS is 20/2000000
(0 votes)
myopicwetcoki_28529.jpg
Myopic Choroidal Neovascular Membrane 54 year old woman 20/20137 views54-year-old woman has had problems in her vision in the right eye for about the last three months. Inferotemporally she sees a gray area, which is distorted. OD is 20/20, OS is 20/2000000
(0 votes)
myopicwetcoki_28629.jpg
Myopic Choroidal Neovascular Membrane 54 year old woman 20/20119 views54-year-old woman has had problems in her vision in the right eye for about the last three months. Inferotemporally she sees a gray area, which is distorted. OD is 20/20, OS is 20/2000000
(0 votes)
myopicwetcoki_28729.jpg
Myopic Choroidal Neovascular Membrane 54 year old woman 20/20106 views54-year-old woman has had problems in her vision in the right eye for about the last three months. Inferotemporally she sees a gray area, which is distorted. OD is 20/20, OS is 20/2000000
(0 votes)
myopicwetcoki_28829.jpg
Myopic Choroidal Neovascular Membrane 54 year old woman 20/20181 views54-year-old woman has had problems in her vision in the right eye for about the last three months. Inferotemporally she sees a gray area, which is distorted. OD is 20/20, OS is 20/2000000
(0 votes)
myopicwetcoki_28929.jpg
Myopic Choroidal Neovascular Membrane 54 year old woman 20/20134 views54-year-old woman has had problems in her vision in the right eye for about the last three months. Inferotemporally she sees a gray area, which is distorted. OD is 20/20, OS is 20/2000000
(0 votes)
myopicwetcoki_281029.jpg
Myopic Choroidal Neovascular Membrane 54 year old woman 20/20173 views54-year-old woman has had problems in her vision in the right eye for about the last three months. Inferotemporally she sees a gray area, which is distorted. OD is 20/20, OS is 20/2000000
(0 votes)
 
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54-year-old woman has had problems in her vision in the right eye for about the last three months. I saw her in May and everything looked okay. She comes back today noting for the last few weeks a substantial change in the paracentral vision in the right eye. Inferotemporally she sees a gray area, which is distorted. She did have a severe coughing problem where she had to take off work for four days when this came on. Her vision in the left eye is fine. VISUAL ACUITY: Vision OD is 20/20, OS is 20/20. IOP: OD 14. The right eye has 1+ nuclear sclerosis. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. There are patchy pigment irregularities in the macula. Superonasal to the fovea there is a well-circumscribed area of thickening of the pigment epithelium, which is hyperpigmented with a donut-shaped hemorrhage around the edge of it, extending about 100 microns off the side of the scar. The entire complex is about a disc diameter in size and is about a disc diameter away from the central fovea. OCT SCAN: There is edema superonasal to the fovea in the area of the hemorrhage. FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA shows a classic extrafoveal choroidal neovascular membrane with hemorrhage around the edge of it. IMPRESSION: 1. WET AGE-RELATED MACULAR DEGENERATION – RIGHT EYE 2. MYOPIC MACULAR DEGENERATION – RIGHT EYE 3. HEMORRHAGIC PIGMENT EPITHELIAL DETACHMENT – RIGHT EYE DISCUSSION: I explained to the patient with the new onset of bleeding in the right eye from the choroidal neovascular membrane, it is reasonable to consider treatment with intravitreal Avastin or Lucentis. Either treatments include choroidal laser and photodynamic laser, both of which might be helpful in this case but could leave scarring blind spots. At this moment, the standard of care is switched to the injectable treatments because of the low-risk. The office visit included a 15-minute counseling session during which I reviewed the alternatives, risks, benefits and limitations of various treatment options. I injected the eye with Avastin (1.25 mg/0.05 ml) without any difficulty. I asked her to return for check in one month, sooner should she notice any problem. She understands this is an ongoing therapy and she will need treatments at least for awhile. She will return urgently should she notice any problem. She will see you back regularly. Treatment was done for about 9 months with a total of 6 shots and then stopped with no recurrence for one year.