Last additions - CNVM - new CNVM no leakage on OCT 86-year-old man has had changing vision. He says his vision has been gradually declining since I saw him in June. You saw a hemorrhage in the eye and suggested he comes in here for an evaluation. He is on Combigan and Travatan in the right eye for his glaucoma.
VISUAL ACUITY: Vision OD is 6/200, OS is 8/200. IOP: OD 15, OS 13. The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.6. The macula is flat. There is a hemorrhage superior to the fovea.
OS: Vertical C/D ratio is 0.6. The macula is flat. There is atrophy nasal to the fovea.
OCT SCAN: The OCT scan shows no intraretinal or subretinal fluid in either eye. There is, however, retinal atrophy.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: FA shows a classic subfoveal choroidal neovascular membrane in the right eye, 2-disc diameters across, in a cartwheel-style appearance. The edge of the membrane superiorly is where the hemorrhage hypofluoresces. The left eye has hyperfluorescence in a geographic area corresponding to the atrophy.
IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES
2. WET AGE-RELATED MACULAR DEGENERATION – RIGHT EYE
3. GLAUCOMA – RIGHT EYE
4. GEOGRAPHIC ATROPHY – LEFT EYE
DISCUSSION: I explained to the patient the macula in the right eye is wet even though interestingly the OCT does not show subretinal fluid. I suggest we try Lucentis in that eye to improve his vision. Recently that has been his better eye. He will return in the near future for his first Lucentis treatment and then he will see you back periodically.
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Vision Loss, Blood, and Cartwheel CNVM OD with no fluid on OCT Scan608 views86-year-old man has had changing vision. He says his vision has been gradually declining since I saw him in June. You saw a hemorrhage in the eye and suggested he comes in here for an evaluation. He is on Combigan and Travatan in the right eye for his glaucoma.
VISUAL ACUITY: Vision OD is 6/200 OS is 8/200 The macula in the right eye is wet even though interestingly the OCT does not show subretinal fluid.Apr 14, 2011
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Vision Loss, Blood, and Cartwheel CNVM OD with no fluid on OCT Scan577 views86-year-old man has had changing vision. He says his vision has been gradually declining since I saw him in June. You saw a hemorrhage in the eye and suggested he comes in here for an evaluation. He is on Combigan and Travatan in the right eye for his glaucoma.
VISUAL ACUITY: Vision OD is 6/200 OS is 8/200 The macula in the right eye is wet even though interestingly the OCT does not show subretinal fluid.Apr 14, 2011
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Vision Loss, Blood, and Cartwheel CNVM OD with no fluid on OCT Scan554 views86-year-old man has had changing vision. He says his vision has been gradually declining since I saw him in June. You saw a hemorrhage in the eye and suggested he comes in here for an evaluation. He is on Combigan and Travatan in the right eye for his glaucoma.
VISUAL ACUITY: Vision OD is 6/200 OS is 8/200 The macula in the right eye is wet even though interestingly the OCT does not show subretinal fluid.Apr 14, 2011
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Vision Loss, Blood, and Cartwheel CNVM OD with no fluid on OCT Scan559 views86-year-old man has had changing vision. He says his vision has been gradually declining since I saw him in June. You saw a hemorrhage in the eye and suggested he comes in here for an evaluation. He is on Combigan and Travatan in the right eye for his glaucoma.
VISUAL ACUITY: Vision OD is 6/200 OS is 8/200 The macula in the right eye is wet even though interestingly the OCT does not show subretinal fluid.Apr 14, 2011
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Vision Loss, Blood, and Cartwheel CNVM OD with no fluid on OCT Scan741 views86-year-old man has had changing vision. He says his vision has been gradually declining since I saw him in June. You saw a hemorrhage in the eye and suggested he comes in here for an evaluation. He is on Combigan and Travatan in the right eye for his glaucoma.
VISUAL ACUITY: Vision OD is 6/200 OS is 8/200 The macula in the right eye is wet even though interestingly the OCT does not show subretinal fluid.Apr 14, 2011
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Vision Loss, Blood, and Cartwheel CNVM OD with no fluid on OCT Scan805 views86-year-old man has had changing vision. He says his vision has been gradually declining since I saw him in June. You saw a hemorrhage in the eye and suggested he comes in here for an evaluation. He is on Combigan and Travatan in the right eye for his glaucoma.
VISUAL ACUITY: Vision OD is 6/200 OS is 8/200 The macula in the right eye is wet even though interestingly the OCT does not show subretinal fluid.Apr 14, 2011
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Vision Loss, Blood, and Cartwheel CNVM OD with no fluid on OCT Scan657 views86-year-old man has had changing vision. He says his vision has been gradually declining since I saw him in June. You saw a hemorrhage in the eye and suggested he comes in here for an evaluation. He is on Combigan and Travatan in the right eye for his glaucoma.
VISUAL ACUITY: Vision OD is 6/200 OS is 8/200 The macula in the right eye is wet even though interestingly the OCT does not show subretinal fluid.Apr 14, 2011
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Vision Loss, Blood, and Cartwheel CNVM OD with no fluid on OCT Scan654 views86-year-old man has had changing vision. He says his vision has been gradually declining since I saw him in June. You saw a hemorrhage in the eye and suggested he comes in here for an evaluation. He is on Combigan and Travatan in the right eye for his glaucoma.
VISUAL ACUITY: Vision OD is 6/200 OS is 8/200 The macula in the right eye is wet even though interestingly the OCT does not show subretinal fluid.Apr 14, 2011
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Vision Loss, Blood, and Cartwheel CNVM OD with no fluid on OCT Scan718 views86-year-old man has had changing vision. He says his vision has been gradually declining since I saw him in June. You saw a hemorrhage in the eye and suggested he comes in here for an evaluation. He is on Combigan and Travatan in the right eye for his glaucoma.
VISUAL ACUITY: Vision OD is 6/200 OS is 8/200 The macula in the right eye is wet even though interestingly the OCT does not show subretinal fluid.Apr 14, 2011
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Vision Loss, Blood, and Cartwheel CNVM OD with no fluid on OCT Scan786 views86-year-old man has had changing vision. He says his vision has been gradually declining since I saw him in June. You saw a hemorrhage in the eye and suggested he comes in here for an evaluation. He is on Combigan and Travatan in the right eye for his glaucoma.
VISUAL ACUITY: Vision OD is 6/200 OS is 8/200 The macula in the right eye is wet even though interestingly the OCT does not show subretinal fluid.Apr 14, 2011
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86-year-old man has had changing vision. He says his vision has been gradually declining since I saw him in June. You saw a hemorrhage in the eye and suggested he comes in here for an evaluation. He is on Combigan and Travatan in the right eye for his glaucoma.
VISUAL ACUITY: Vision OD is 6/200, OS is 8/200. IOP: OD 15, OS 13. The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.6. The macula is flat. There is a hemorrhage superior to the fovea.
OS: Vertical C/D ratio is 0.6. The macula is flat. There is atrophy nasal to the fovea.
OCT SCAN: The OCT scan shows no intraretinal or subretinal fluid in either eye. There is, however, retinal atrophy.
PHOTOGRAPHS: Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: FA shows a classic subfoveal choroidal neovascular membrane in the right eye, 2-disc diameters across, in a cartwheel-style appearance. The edge of the membrane superiorly is where the hemorrhage hypofluoresces. The left eye has hyperfluorescence in a geographic area corresponding to the atrophy.
IMPRESSION: 1. AGE-RELATED MACULAR DEGENERATION – BOTH EYES
2. WET AGE-RELATED MACULAR DEGENERATION – RIGHT EYE
3. GLAUCOMA – RIGHT EYE
4. GEOGRAPHIC ATROPHY – LEFT EYE
DISCUSSION: I explained to the patient the macula in the right eye is wet even though interestingly the OCT does not show subretinal fluid. I suggest we try Lucentis in that eye to improve his vision. Recently that has been his better eye. He will return in the near future for his first Lucentis treatment and then he will see you back periodically.
