Degenerative Maculopathy - additional opinion
81-year-old female with age related macular generation in both eyes. In the expert's opinion, she suffers from Non- Neovascular AMD with high risk characteristics to transform to the Neovascular form, and therefore she should have a retinal follow-up every 4 months, and receive the AREDS formulations of vitamins and minerals, that reduce the risk of losing vision from this condition.
A patient with Degenerative Maculopathy asks for the expert's impression about the diagnosis, treatment options and prognosis.
81-year-old lady. She was examined on March 2008 by Dr. S. who found a visual acuity of 3/10 (6/20) in the right eye, and 6/10 in the left, and a normal intraocular pressure of 16 mmHg in both eyes. Ocular examination revealed the state of pseudophakia with open posterior capsule (namely the fact that the patient underwent in her past surgery for cataract removal and implantation of posterior chamber intraocular synthetic lens, followed by opening of the capsule by YAG laser in both eyes).
Fluorescein angiography performed on Dec 2007, shows in both eyes the existence of multiple hyperfluorescent dots, with hyperfluoresence fading along the course of the angiogram, namely, showing numerous (> 6) large (> 125 μ in size) drusen (the primary hallmark of age related macular degeneration (AMD) as well as pigment epithelial atrophy (the second hallmark of AMD). This is compatible with the diagnosis of non Neovascular AMD. There are no signs of leakage which could suggest the existence of pathological blood vessels in the form of choroidal neovascularization (CNV) namely Neovascular AMD. It is stated that the situation was similar to the one seen on a previous fluorescein angiography examination, but this was not available to me.
OCT, performed February 2008, shows a normal foveal thickness and the existence of drusen and atrophy of the pigment epithelium with no signs of neovascularization in the right eye. In the left eye there is a similar appearance, as well as a very fine epiretinal membrane.
Impression and recommendation:
The above referenced patient suffers from Non- Neovascular AMD with high risk characteristics to transform to the Neovascular form of the disease. The Epiretinal membrane is not significant at this point. Due to the number of drusen and their size, associated with abnormalities of the pigment epithelium, the chances of developing CNV (Neovascular AMD) are around 40% in 5 years. Therefore, monitoring is warranted in the form of self assessment of visual acuity as well as examination by a retina specialist at a 4 months interval, and upon any decrease in visual acuity or metamorphopsia. In addition, in order to reduce these chances developing Neovascular AMD the patient should be taking vitamins as per the recommendations of the AREDS study, namely vitamin C 500 mg, vitamin E 400 mg, Zinc 80 mg, and, in case she is not smoking and did not smoke for the last 15 years, also beta carotene 15000 IU. These can be taken in various formulations, for example Ocuvite Preservision in the United States.
I would be happy to see this patient in my practice if he wishes to travel to the Israel, however, it seems to me that she should continue her follow up by a retina specialist in her country.