A blog dedicated to providing a resource for medical students interested in all things retina. This is solely moderated by medical students and, while we take every effort to be accurate, it does not represent a definitive reference...we just want to put the FUN in fundus!
The above images represent a 79 year old caucasian female. She presented to the clinic due to worsening of vision. Which eye prompted this patient to come in for this visit?
Those both look bad. The right eye looks like there are large areas on necrosis and the optic nerve also has necrosis around the nerve. I wouldn't expect that patient to really be able to see out of that eye at all. The left eye looks like a hemorrhage on an around the macula with nerosis in the inferior temporal region. If this patient had already been relying on her left eye for vision, and then had a bleed in the area of her macula, it may have been the one that prompted her visit.
Right on, Brett. Usually, when patients report an acute change in vision, its in the better eye. This is because, as you pointed out, they are relying on the good eye for their functional vision. In this case, you are correct, both eyes are displaying advanced pathology. It could be much more subtle though, in the case of worsening macular edema OS, for example. The key is that the right eye shows very chronic disease as evidenced by the densely fibrotic, or disciform, scar. The patient has a very large, dense central scotoma. The areas that you identify as necrotic, are more atrophic, to be more precise.
The above images represent a 79 year old caucasian female. She presented to the clinic due to worsening of vision. Which eye prompted this patient to come in for this visit?
Those both look bad. The right eye looks like there are large areas on necrosis and the optic nerve also has necrosis around the nerve. I wouldn't expect that patient to really be able to see out of that eye at all. The left eye looks like a hemorrhage on an around the macula with nerosis in the inferior temporal region. If this patient had already been relying on her left eye for vision, and then had a bleed in the area of her macula, it may have been the one that prompted her visit.
ReplyDeleteRight on, Brett. Usually, when patients report an acute change in vision, its in the better eye. This is because, as you pointed out, they are relying on the good eye for their functional vision. In this case, you are correct, both eyes are displaying advanced pathology. It could be much more subtle though, in the case of worsening macular edema OS, for example. The key is that the right eye shows very chronic disease as evidenced by the densely fibrotic, or disciform, scar. The patient has a very large, dense central scotoma. The areas that you identify as necrotic, are more atrophic, to be more precise.
ReplyDelete