Last additions - Angioid Streaks - New CNVM Right Eye Scar Left Eye 53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted. It is very far from the central vision.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. IOP: 21 OU.
SLIT LAMP EXAM: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.3. There is thickening of the pigment epithelium just adjacent to the optic nerve and there is a hemorrhage superior to the macula. The hemorrhage superior to the fovea is 3000 microns from the fovea and it encompasses an area about 600 microns across.
OS: Vertical C/D ratio is 0.3. There is a white subfoveal disciform scar.
OCT SCAN: The right eye shows a normal foveal contour, however, just adjacent to the optic nerve, there is an area where there is some thickening of the pigment epithelium with possible trace overlying subretinal fluid.
FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA of the right eye shows a hyperfluorescent area which looks to be a 500-micron classic extrafoveal asymptomatic choroidal neovascular membrane superior to the fovea, 3000 microns from the center. There is also a hyperfluorescent glow around the optic nerve. The left eye has a staining macula.
IMPRESSION:
1. ANGIOID STREAKS
2. MACULAR SCAR – LEFT EYE
3. ASYMPTOMATIC EXTRAFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE SUPERIOR TO THE MACULA – RIGHT EYE
4. POSSIBLE OCCULT JUXTAPAPILLARY CHOROIDAL NEOVASCULAR MEMBRANE, WHICH IS SYMPTOMATIC NASAL TO THE MACULA
DISCUSSION: I explained to the patient there are two areas which look like they may be activating in his right eye with neovascularization. The area superior to the macula has hemorrhage around it but is asymptomatic. The area nasal to the macula is not definitive on choroidal neovascular membrane. Both of these areas are greater than 2 mm from the fovea, and therefore not an immediate threat. I suggest we leave the eyes alone and have him return for check in a month. If these areas grow, then he will need to start treatment with Avastin. He knows to return urgently should he notice a striking change.
Patient subsequently received treatment using treat and extend with Lucentis and is not 3 years out with good vision in this eye.
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis684 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis493 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis526 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis417 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis446 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis480 views553-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis433 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis445 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis574 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis481 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis609 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis469 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis470 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis493 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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Angioid Streaks New Vision Change in Good Right Eye Treated with Lucentis719 views53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. Treatment was started within a month and patient responded well and is now 3 years out requiring every 3 month LucentisNov 21, 2010
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53-year-old man has angioid streaks. He has a macular scar in the left eye from choroidal neovasculari-zation that was treated with photodynamic laser 5-8 years ago. His vision in the right eye had been fine until about a week ago when he noticed temporally in the right eye an area that does not look normal and looks a little distorted. It is very far from the central vision.
VISUAL ACUITY: Vision OD is 20/30, OS is 20/400. IOP: 21 OU.
SLIT LAMP EXAM: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.3. There is thickening of the pigment epithelium just adjacent to the optic nerve and there is a hemorrhage superior to the macula. The hemorrhage superior to the fovea is 3000 microns from the fovea and it encompasses an area about 600 microns across.
OS: Vertical C/D ratio is 0.3. There is a white subfoveal disciform scar.
OCT SCAN: The right eye shows a normal foveal contour, however, just adjacent to the optic nerve, there is an area where there is some thickening of the pigment epithelium with possible trace overlying subretinal fluid.
FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA of the right eye shows a hyperfluorescent area which looks to be a 500-micron classic extrafoveal asymptomatic choroidal neovascular membrane superior to the fovea, 3000 microns from the center. There is also a hyperfluorescent glow around the optic nerve. The left eye has a staining macula.
IMPRESSION:
1. ANGIOID STREAKS
2. MACULAR SCAR – LEFT EYE
3. ASYMPTOMATIC EXTRAFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE SUPERIOR TO THE MACULA – RIGHT EYE
4. POSSIBLE OCCULT JUXTAPAPILLARY CHOROIDAL NEOVASCULAR MEMBRANE, WHICH IS SYMPTOMATIC NASAL TO THE MACULA
DISCUSSION: I explained to the patient there are two areas which look like they may be activating in his right eye with neovascularization. The area superior to the macula has hemorrhage around it but is asymptomatic. The area nasal to the macula is not definitive on choroidal neovascular membrane. Both of these areas are greater than 2 mm from the fovea, and therefore not an immediate threat. I suggest we leave the eyes alone and have him return for check in a month. If these areas grow, then he will need to start treatment with Avastin. He knows to return urgently should he notice a striking change.
Patient subsequently received treatment using treat and extend with Lucentis and is not 3 years out with good vision in this eye.
