Progressive Macular Degeneration

An 82-year-old woman consulted her ophthalmologist because the vision in her left eye was becoming progressively blurrier. The patient was pseudophakic and had bilateral glaucoma, for which she used latanoprost ophthalmic solution.

Her best corrected visual acuity was 20/40 in the right eye and 20/60 in the left eye. Her intraocular pressures were normal. The right fundus showed pigment mottling and drusen in the macula, typical findings in dry age-related macular degeneration (ARMD). The left macula showed pigment disruption, drusen, and a macular hemorrhage. This new bleeding indicated that the patient's dry ARMD had progressed to the wet form in her left eye.

The patient was referred to a retina specialist; fluorescein angiography confirmed an occult subretinal neovascular membrane. She underwent 2 sessions of focal macular laser therapy. Although the leaky membrane was sealed, the patient's vision in the left eye decreased to finger counting at 2 feet.

The patient was seen again by her original ophthalmologist 3 years later. She had no new symptoms, but the visual acuity in her left eye remained poor (finger counting at 1½ feet). The vision in her right eye was stable at 20/40. Fundus examination of the left eye showed a large post-laser disciform macular scar. Evidence of a new retinal perimacularhemorrhage was also present. Because of the patient's poor vision potential in the left eye, no treatment was deemed necessary.