Last additions - Reticular Macular Disease with Occult CNVM Right Eye 80-year-old woman noticed decreasing vision for sometime between the last six to twelve months. She is a voracious reader. She finds she is having difficulty reading and seeing well. You saw a problem with the retina and suggest she come here for an evaluation. She also was told that you were considering laser for posterior capsular opacities.
VISUAL ACUITY: OD 20/40, OS 20/63. IOP: OD 12, OS 13.
SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.3. There is posterior vitreous separation. There is hemorrhage inferotemporal to the fovea with subretinal fluid.
OS: Vertical C/D ratio is 0.3. There is posterior vitreous separation and 2+ macular drusen.
SPECTRALIS-SD-OCT SCAN: The OCT scan of the right eye shows intraretinal and subretinal fluid as well as pigment epithelium thickening inferotemporal to the fovea. The OCT scan of the left eye does show patchy drusen, but there is no intraretinal or subretinal fluid. Photos confirm clinical findings.
FUNDUS AUTO FLUORESCENCE: The infra red and auto fluorescence images show reticular macular disease.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography of the right eye shows an occult subfoveal choroidal neovascular membrane a disc area in size centered inferotemporal to the fovea, which leaks in the late frames. The angiogram of the left eye shows a few hyperfluorescence spots around the macula, which stain, but don’t leak.
INDOCYANINE GREEN ANGIOGRAPHY: The indocyanine green angiogram shows a disc area of neovascular membrane inferotemporal to the fovea. There is no evidence of any polypoidal choroidal vasculopathy. In the left eye the indocyanine green angiogram shows no leakage and all the testing does show significant reticular pseudo drusen.
IMPRESSION:
1. WET AGE-RELATED MACULAR DEGENERATION – RIGHT EYE
2. OCCULT SUBFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE - RIGHT EYE
3. MACULAR HEMORRHAGE – RIGHT EYE
4. PIGMENT EPITHELIAL DETACHMENT – RIGHT EYE
5. RETICULAR MACULAR DISEASE – BOTH EYES
DISCUSSION: I explained to the patient the right eye does have wet age-related macular degeneration. With Avastin there is a 90 percent chance of improving the vision some and a 50 percent chance of improving the vision a lot. I explained to her that all the treatments are safe and effective. It does often require ongoing therapy at least for a while.
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye708 viewsIndocyanine Green AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 630 viewsIndocyanine Green AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 542 viewsIndocyanine Green AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 575 viewsIndocyanine Green AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 508 viewsIndocyanine Green AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 572 viewsIndocyanine Green AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 599 viewsIndocyanine Green AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 569 viewsIndocyanine Green AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 572 viewsIndocyanine Green AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 636 viewsFluorescein AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 628 viewsFluorescein AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 592 viewsFluorescein AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 641 viewsFluorescein AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 592 viewsFluorescein AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 520 viewsFluorescein AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 592 viewsFluorescein AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 539 viewsFluorescein AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 587 viewsFluorescein AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 558 viewsFluorescein AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 565 viewsFluorescein AngiogramApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 853 viewsSpectral Domain Optical Coherence TomographyApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 1372 viewsSpectral Domain Optical Coherence TomographyApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 639 viewsSpectral Domain Optical Coherence TomographyApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 690 viewsSpectral Domain Optical Coherence TomographyApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 674 viewsSpectral Domain Optical Coherence TomographyApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 685 viewsSpectral Domain Optical Coherence TomographyApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 611 viewsSpectral Domain Optical Coherence TomographyApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 608 viewsSpectral Domain Optical Coherence TomographyApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 584 viewsFundus AutofluorescenceApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 565 viewsFundus AutofluorescenceFundus AutofluorescenceApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 614 viewsFundus AutofluorescenceApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 578 viewsInfra-RedApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 526 viewsApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 659 viewsInfra-RedApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 719 viewsInfra-RedApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 625 viewsInfra-RedApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 615 viewsColor Fundus PhotoApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 616 viewsColor Fundus PhotoApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 649 viewsColor Fundus PhotoApr 08, 2013
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Reticular Macular Disease (Pseudo-drusen) Both Eyes - Occult CNVM and Macular Edema Right Eye 722 viewsColor Fundus PhotoApr 08, 2013
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80-year-old woman noticed decreasing vision for sometime between the last six to twelve months. She is a voracious reader. She finds she is having difficulty reading and seeing well. You saw a problem with the retina and suggest she come here for an evaluation. She also was told that you were considering laser for posterior capsular opacities.
VISUAL ACUITY: OD 20/40, OS 20/63. IOP: OD 12, OS 13.
SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.3. There is posterior vitreous separation. There is hemorrhage inferotemporal to the fovea with subretinal fluid.
OS: Vertical C/D ratio is 0.3. There is posterior vitreous separation and 2+ macular drusen.
SPECTRALIS-SD-OCT SCAN: The OCT scan of the right eye shows intraretinal and subretinal fluid as well as pigment epithelium thickening inferotemporal to the fovea. The OCT scan of the left eye does show patchy drusen, but there is no intraretinal or subretinal fluid. Photos confirm clinical findings.
FUNDUS AUTO FLUORESCENCE: The infra red and auto fluorescence images show reticular macular disease.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography of the right eye shows an occult subfoveal choroidal neovascular membrane a disc area in size centered inferotemporal to the fovea, which leaks in the late frames. The angiogram of the left eye shows a few hyperfluorescence spots around the macula, which stain, but don’t leak.
INDOCYANINE GREEN ANGIOGRAPHY: The indocyanine green angiogram shows a disc area of neovascular membrane inferotemporal to the fovea. There is no evidence of any polypoidal choroidal vasculopathy. In the left eye the indocyanine green angiogram shows no leakage and all the testing does show significant reticular pseudo drusen.
IMPRESSION:
1. WET AGE-RELATED MACULAR DEGENERATION – RIGHT EYE
2. OCCULT SUBFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE - RIGHT EYE
3. MACULAR HEMORRHAGE – RIGHT EYE
4. PIGMENT EPITHELIAL DETACHMENT – RIGHT EYE
5. RETICULAR MACULAR DISEASE – BOTH EYES
DISCUSSION: I explained to the patient the right eye does have wet age-related macular degeneration. With Avastin there is a 90 percent chance of improving the vision some and a 50 percent chance of improving the vision a lot. I explained to her that all the treatments are safe and effective. It does often require ongoing therapy at least for a while.