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Retina Review: A Retina Case Study by Amir Mohsenin, MD, PhD

HPI

  • 83 years old 
  • Caucasian male
  • Referred for distortion and a black central spot in the right eye for the last 2 months

VISION

  • OD:  20/100
  • OS:  20/20

SIGNIFICANT EXAM FINDINGS

  • OD: drusen, subretinal hemorrhage and atrophic changes in the macula
  • OS: macular drusen

FUNDUS PHOTOS

OD:

OS:

OCT

OD:

OS:

DIAGNOSIS

  • Wet age-related macular degeneration, right eye
  • Dry age-related macular degeneration, left eye

PLAN

  • Same-day treatment with intravitreal aflibercept (Eylea) OD followed by a series of 2 more monthly aflibercept injections. Complete exam after the third injection.
  • Recommend healthy diet (Mediterranean), exercise, sun protection, no smoking and AREDS II vitamins
  • Amsler grid

F/U

  • 1 month for aflibercept injection #2 OD

OUTCOMES

  • Vision went from 20/100 OD to 20/20 OD after 2 injections
  • OCT shows improved retinal anatomy and resolution of the subretinal hyperreflective material.

OD before injection:

OD after 2 injections of aflibercept:

PEARLS

  • Wet AMD only accounts for ~10% of all AMD but is responsible for 90% of AMD- associated vision loss.
  • AMD is the number 1 cause of vision loss in patients over age 65 in the USA
  • Biggest modifiable risk factor is smoking. I really push the patient to quit and will keep doing so every visit if they are a smoker. I also recruit family members to help them quit and recommend they ask their PCP for programs and/or medications to help. 
  • New conversions from dry to wet AMD should be seen urgently. The biggest fear is a large submacular hemorrhage like this one:

As always, feel free to contact me directly via phone or text with any questions. If I don’t answer I may be in surgery or with a patient. You can always reach my office manager, Betsy Roberts at (713) 791-9620 or my surgical coordinator Debbie Rider at (713) 791-1790 as well.

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