Age Related Macular Degeneration and Polypoidal Choroidal Vasculopathy
Short summary
61-year-old male with a history of Central Serous Chorioretinopathy had a sudden decrease in vision in his right eye. He was seen by an ophthalmologist who found a large hemorrhage in the macula. He then consulted with professor who diagnosed him as having Polypoidal Choroidal Vasculopathy and he had an intravitreal injection of Avastin. Following this, the patient had a Vitrectomy operation. Photographs and Indocyanine angiography show a large subretinal hemorrhage, consistent with Age Related Macular Degeneration, and perhaps Polypoidal Choroidal Vasculopathy. In the expert's opinion, the patient has age related macular degeneration of the wet type in his right eye, and most probably, of the dry type in the left eye. A treatment option would be additional Lucentis or Avastin intravitreal injections, and the patient should consider vitamin supplements, using dark eyeglasses and plenty of green leafy vegetables.
Patient's questions
The patient asks about treatment alternatives and about centers of excellence.
Medical Background
The patient is a 61 year old male with a history of Central Serous Chorioretinopathy in 1991. In November of 2007, he had a sudden decrease in vision in his right eye, lasting for about 10 days.
On November 2007, the patient was seen by an ophthalmologist who diagnosed him as having a large hemorrhage in the macula of the right eye. Visual Acuity was 0.2 in the right eye and 1.0 in the left eye. The left eye exam was normal at that time.
Two days later the patient consulted with Professor L. who diagnosed him as having Polypoidal Choroidal Vasculopathy in his right eye. Two days later he had an intravitreal injection of Avastin in the right eye. Course after the injection was uneventful with vision improving to 0.4 in the right eye.
Following this, the patient had a Vitrectomy operation in the right eye and four weeks later his vision was 0.25 in the right eye and 1.25 in the left eye.
Photographs and Indocyanine angiography show in the right eye a large subretinal hemorrhage with leakage of dye in the late phases of the angiogram, consistent with Age Related Macular Degeneration, and perhaps Polypoidal Choroidal Vasculopathy. Optical Coherence Tomography also shows thickening of the retina and the choroid consistent with the same diagnosis.
Medical opinion
In summary, the patient has Age Related macular degeneration of the wet type in his right eye, and most probably, of the dry type in the left eye. Unfortunately, no color photos of the left eye were provided so that the status of the left eye is not clear to me at this time.
Treatment alternatives
At this time it seems that the right macula has a macular scar. If intraretinal fluid and subretinal fluid is still present a treatment option would be additional Lucentis or Avastin intravitreal injections. Most probably this treatment will not improve the vision of the right eye very significantly because of the damage induced by the disease.
The patient should be aware that age related macular degeneration can decrease significantly the ability to see small details but it never produces complete blindness.
As for the Left eye, the patient needs to monitor his vision carefully using an Amsler Grid chart. If there are any changes in vision in the left eye, the patient should be seen immediately by an Ophthalmologist.
The patient should consider taking vitamin supplements according to the AREDS study if large drusen are present in the left eye. I would also recommend the use of dark eyeglasses when the patient is under sunny conditions outside. Lastly, I would recommend the patient to eat plenty of green leafy vegetables.
If any wet or exudative age related lesion appears in the left eye the patient should consider therapy with Lucentis or Avastin intravitreal injections.
Centers of excellence
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.
I would be happy to see this patient in my practice at the University of Pennsylvania Health System.
