Adult Vitelliform Pattern Dystrophy One Eye Only
|
|
She reports her vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
She reports in the past she had some rapid changes in vision and underwent intravitreal injections at that time by an outside retinal specialist. She reports her left eye is her clearer eye and has been for some time.
Visual acuity with correction of 20/60+1 OD, 20/25 OS. She reads with correction J7 OD, J2 OS. IOP: 14 OU.
SLIT LAMP EXAM: Biomicroscopy reveals a quiet anterior segment with a stable IOL present. The anterior vitreous is syneretic OU.
POSTERIOR SEGMENT EXAM: There is a vitreous separation in both eyes. C/D ratio is 0.5 OD, 0.7 OS. Large retinal vasculature shows diffuse mild arteriolar sclerosis with diffuse 1+ arteriovenous crossing changes. The macula shows a yellow vitelliform lesion at the fovea in the right and drusen present in the left eye. There is no subretinal fluid or hemorrhage visible in either eye. The macular pigment is intact outside the vitelliform lesion in the right and the left macula has fairly intact pigment outside the drusen.
EXTENDED OPHTHALMOSCOPY: The retinal periphery is flat and intact with no tears, breaks, or detachments with scleral depression.
OCT SCAN: There is subretinal pigment epithelial elevation present with no subretinal fluid or hemorrhage. The left eye has intact neurosensory retinal tissue with some loss of photoreceptor junctional segments and slight thickening of the RPE reflex.
FUNDUS PHOTOGRAPHY: Color and red-free photographs correspond to clinical findings and show the presence of a vitelliform lesion on the right and drusen on the left.
FLUORESCEIN ANGIOGRAPHY: The right eye is transit. Arm-to-eye time and AV transit time are within normal limits. There is minimal hyperfluorescence of the vitelliform lesion in transit phase. As the study progresses through the 1-minute, 2-minute, and 5-minute late phases, there is progressive filling and pooling of dye in the lesion with staining and no leakage outside of its borders. The left eye has staining of drusen which fade in the late phase of the study.
IMPRESSION:
1. ASYMPTOMATIC ADULT VITELLIFORM DYSTROPHY RIGHT EYE GREATER THAN LEFT EYE
2. OPEN ANGLE GLAUCOMA SUSPECT BY CUP-TO-DISC RATIO, REMOTE HISTORY OF OBSERVATION
3. HISTORY OF POSSIBLE WET MACULAR DEGENERATION WITH REMOTE INTRAVITREAL ANTIANGIOGENIC TREATMENT, LAST ADMINISTERED TWO TO THREE YEARS AGO
4. HYPERTENSION WITH GRADE I-II HYPERTENSIVE RETINOPATHY, UNDER GOOD MEDICAL CONTROL PER PATIENT
5. PSEUDOPHAKIA
6. VITREOUS SEPARATION BOTH EYES
DISCUSSION: she has a macular abnormality consistent with vitelliform changes. I explained that she is unlikely to have this progress to wet macular degeneration. I explained that the previous treatment that she had may have been for a masquerading or simulating lesion and not for a real choroidal neovascular process. I doubt that the two injections she received would have actually quelled that process for this amount of time.
I explained to Ms. Jurkowski that she does have an approximately 25% risk of developing wet macular degeneration as a new diagnosis. I explained that if she has any new changes in her central vision, I would be happy to see her back at a moment’s notice.
To reduce her risk of progression, I recommended antioxidant supplements per the Age-Related Eye Disease Study, a diet rich in naturally occurring antioxidants, and regular monitoring of her vision.
|
Pattern Dystrophy - Adult Vitelliform Dystrophy - Macular Degeneration640 views 78 Year Old Woman with vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
20/60+1 OD, 20/25 OS
(0 votes)
|
|
Pattern Dystrophy - Adult Vitelliform Dystrophy - Macular Degeneration550 views 78 Year Old Woman with vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
20/60+1 OD, 20/25 OS
(0 votes)
|
|
Pattern Dystrophy - Adult Vitelliform Dystrophy - Macular Degeneration558 views 78 Year Old Woman with vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
20/60+1 OD, 20/25 OS
(0 votes)
|
|
Pattern Dystrophy - Adult Vitelliform Dystrophy - Macular Degeneration441 views 78 Year Old Woman with vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
20/60+1 OD, 20/25 OS
(0 votes)
|
|
Pattern Dystrophy - Adult Vitelliform Dystrophy - Macular Degeneration396 views 78 Year Old Woman with vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
20/60+1 OD, 20/25 OS
(0 votes)
|
|
Pattern Dystrophy - Adult Vitelliform Dystrophy - Macular Degeneration341 views 78 Year Old Woman with vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
20/60+1 OD, 20/25 OS
(0 votes)
|
|
Pattern Dystrophy - Adult Vitelliform Dystrophy - Macular Degeneration334 views 78 Year Old Woman with vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
20/60+1 OD, 20/25 OS
(0 votes)
|
|
Pattern Dystrophy - Adult Vitelliform Dystrophy - Macular Degeneration302 views 78 Year Old Woman with vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
20/60+1 OD, 20/25 OS
(0 votes)
|
|
Pattern Dystrophy - Adult Vitelliform Dystrophy - Macular Degeneration362 views 78 Year Old Woman with vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
20/60+1 OD, 20/25 OS
(0 votes)
|
|
Pattern Dystrophy - Adult Vitelliform Dystrophy - Macular Degeneration363 views 78 Year Old Woman with vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
20/60+1 OD, 20/25 OS
(0 votes)
|
|
Pattern Dystrophy - Adult Vitelliform Dystrophy - Macular Degeneration399 views 78 Year Old Woman with vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
20/60+1 OD, 20/25 OS
(0 votes)
|
|
|
|
|
She reports her vision has diminished in the right eye over the past couple of years, but the diminishment has been slow.
She reports in the past she had some rapid changes in vision and underwent intravitreal injections at that time by an outside retinal specialist. She reports her left eye is her clearer eye and has been for some time.
Visual acuity with correction of 20/60+1 OD, 20/25 OS. She reads with correction J7 OD, J2 OS. IOP: 14 OU.
SLIT LAMP EXAM: Biomicroscopy reveals a quiet anterior segment with a stable IOL present. The anterior vitreous is syneretic OU.
POSTERIOR SEGMENT EXAM: There is a vitreous separation in both eyes. C/D ratio is 0.5 OD, 0.7 OS. Large retinal vasculature shows diffuse mild arteriolar sclerosis with diffuse 1+ arteriovenous crossing changes. The macula shows a yellow vitelliform lesion at the fovea in the right and drusen present in the left eye. There is no subretinal fluid or hemorrhage visible in either eye. The macular pigment is intact outside the vitelliform lesion in the right and the left macula has fairly intact pigment outside the drusen.
EXTENDED OPHTHALMOSCOPY: The retinal periphery is flat and intact with no tears, breaks, or detachments with scleral depression.
OCT SCAN: There is subretinal pigment epithelial elevation present with no subretinal fluid or hemorrhage. The left eye has intact neurosensory retinal tissue with some loss of photoreceptor junctional segments and slight thickening of the RPE reflex.
FUNDUS PHOTOGRAPHY: Color and red-free photographs correspond to clinical findings and show the presence of a vitelliform lesion on the right and drusen on the left.
FLUORESCEIN ANGIOGRAPHY: The right eye is transit. Arm-to-eye time and AV transit time are within normal limits. There is minimal hyperfluorescence of the vitelliform lesion in transit phase. As the study progresses through the 1-minute, 2-minute, and 5-minute late phases, there is progressive filling and pooling of dye in the lesion with staining and no leakage outside of its borders. The left eye has staining of drusen which fade in the late phase of the study.
IMPRESSION:
1. ASYMPTOMATIC ADULT VITELLIFORM DYSTROPHY RIGHT EYE GREATER THAN LEFT EYE
2. OPEN ANGLE GLAUCOMA SUSPECT BY CUP-TO-DISC RATIO, REMOTE HISTORY OF OBSERVATION
3. HISTORY OF POSSIBLE WET MACULAR DEGENERATION WITH REMOTE INTRAVITREAL ANTIANGIOGENIC TREATMENT, LAST ADMINISTERED TWO TO THREE YEARS AGO
4. HYPERTENSION WITH GRADE I-II HYPERTENSIVE RETINOPATHY, UNDER GOOD MEDICAL CONTROL PER PATIENT
5. PSEUDOPHAKIA
6. VITREOUS SEPARATION BOTH EYES
DISCUSSION: she has a macular abnormality consistent with vitelliform changes. I explained that she is unlikely to have this progress to wet macular degeneration. I explained that the previous treatment that she had may have been for a masquerading or simulating lesion and not for a real choroidal neovascular process. I doubt that the two injections she received would have actually quelled that process for this amount of time.
I explained to Ms. Jurkowski that she does have an approximately 25% risk of developing wet macular degeneration as a new diagnosis. I explained that if she has any new changes in her central vision, I would be happy to see her back at a moment’s notice.
To reduce her risk of progression, I recommended antioxidant supplements per the Age-Related Eye Disease Study, a diet rich in naturally occurring antioxidants, and regular monitoring of her vision.
