Degenerative Maculopathy
Short summary
81-year-old female with age related macular generation in both eyes, most probably of the dry type. In the expert's opinion, she should have a retinal follow-up every 4 months and check her central vision on a daily basis. As for treatment, she should receive the AREDS formulations of vitamins and minerals, because these medications reduce the risk of losing vision. If she perceive any changes in vision - she should seek an eye examination as soon as possible since this may be the first symptom of the wet type of age related macular degeneration, which can be treated with injections of Lucentis or Avastin.
Patient's questions
A patient with Degenerative Maculopathy asks for the expert's impression about the diagnosis, treatment options and prognosis.
Medical Background
The patient is an 81 years old female diagnosed as having a Degenerative Maculopathy.
On December, 2007 the patient had fundus photography and fluorescein angiography performed in both eyes. Red free photographs provided show evidence of a large number of drusen (white deposits) within the macula of both eyes.
Fluorescein angiographic photographs of the right eye show round areas of hyperfluorescense within the macula, most probably, corresponding to the above mentioned drusen. Because only two images of the sequence of the fluorescein angiograms is provided for each eye, it is difficult to assess whether there is actual leakage of fluorescein, a finding that would suggest the presence of a choroidal neovascular membrane.
Fluorescein angiographic findings of the left eye show areas of hyperfluorescense within the macula. There is no evidence of leakage of fluorescein in the two photographs provided for the left eye.
Optical Coherence Tomographic images of both eyes obtained on February 2008 are also provided.
Right eye shows no evidence of intraretinal, sub-retinal or sub-RPE (Retinal Pigmentary Epithelium) fluid. Increased thickness and reflectivity of the RPE Bruch’s membrane complex is seen with some unevenness and shadowing of the choriocapilaries probably due to the presence of large drusen.
Left eye shows similar OCT findings.
Findings from an examination of Dr. S. of March 2008 mention visual acuities of 3/10 with eyeglass correction in the right eye and 6/10 in the left eye. Surgical pseudophakia with a Yag Laser Capsulotomy the right eye, Intraocular pressure in the normal range (16 mmHg). There are signs of age related macular degeneration with initial atrophy without any fluorescein angiographic evidence of choroidal neovascularization.
Medical opinion
No details of the patient’s complaints or her history have been submitted to me.
Red free photographs provided show evidence of a large number of drusen (white deposits) within the macula of both eyes. This is a typical change observed in patients with age related macular degeneration.
Fluorescein angiographic photographs of the right eye show round areas of hyperfluorescense within the macula, most probably, corresponding to the above mentioned drusen.
Impression
The patient has age related macular degeneration in both eyes, most probably of the dry type. The patient should return for follow up with an Ophthalmologist in the near future.
Treatment options
The patients should receive the AREDS formulation of vitamins and minerals. If she is not a smoker, I would recommend Ocuvite Preservision one gel cap twice daily. If she is a smoker, she should probably take instead Ocuvite Lutein one gel cap twice daily. The patient should also check her central vision on a daily basis using an Amsler grid chart. If she perceives any changes in her vision, she should seek an eye examination, as soon as possible since this may be the first symptom of the wet type of age related macular degeneration.
The reason that this is very important is that we have today good treatment options with injections of Lucentis or Avastin if she were to develop the wet type of age related macular degeneration.
I would also recommend her to wear dark eye shades when she is outside in the sun and to eat plenty of dark green vegetables.
Prognosis:
The prognosis will depend on whether she develops any wet age related macular degeneration. This type of macular degeneration can reduce significantly the central vision. However, she should know that age related macular degeneration does not cause complete blindness.
It is important that she takes the AREDS formulation because this medications reduce by one third the risk of loosing vision from this condition.
Centers of Excellence:
- University Hospital San Raffaele, Milano.
- The Wilmer Institute at John Hopkins, in Baltimore.
- The Scheie Eye Institute at the University of Pennsylvania, in Philadelphia.
- The Bascom Palmer Institute, in Miami.
