Retina

Case 57

Contributor: Marko Tien (University of British Columbia Medical Student) 

Patient Presentation: A 79-year-old woman with advanced macular degeneration was referred for assessment and management. She complains of blurriness OU with a blind spot in the upper visual field of the right eye. Her ocular history is significant for bilateral cataract extraction done 12 years ago, and regular intravitreal ranibizumab injections in the right eye up until 10 years ago. She is taking Vitalux (AREDS2), dorzolamide-timolol and monoprost drops OU, sertraline, and pantoprazole. No significant FHx. On presentation, visual acuity was 20/200-2 OD and 20/150-2 OS.

Question: OCT macula 5-line raster was performed in the right and left eye. Which of the following OCT findings is NOT seen?

Question: What does this OCT demonstrate?

Question: What is the best course of treatment for this patient?

References:

  1. Complications of Age-Related Macular Degeneration Prevention Trial Research Group (2006). Laser treatment in patients with bilateral large drusen: the complications of age-related macular degeneration prevention trial. Ophthalmology, 113(11), 1974–1986. https://doi.org/10.1016/j.ophtha.2006.08.015

  2. Friberg, T. R., Musch, D. C., Lim, J. I., Morse, L., Freeman, W., Sinclair, S., & PTAMD Study Group (2006). Prophylactic treatment of age-related macular degeneration report number 1: 810-nanometer laser to eyes with drusen. Unilaterally eligible patients. Ophthalmology, 113(4), 622.e1. https://doi.org/10.1016/j.ophtha.2005.10.066

  3. Ivana N. Despotovic, Daniela Ferrara. 6.1.2 - Geographic Atrophy. Editor(s): Darin R. Goldman, Nadia K. Waheed, Jay S. Duker. Atlas of Retinal OCT: Optical Coherence Tomography. Elsevier,2018. Pages 24-27. ISBN 9780323461214. https://doi.org/10.1016/B978-0-323-46121-4.00010-8. (https://www.sciencedirect.com/science/article/pii/B9780323461214000108)

  4. Sadda, S. R., Guymer, R., Holz, F. G., Schmitz-Valckenberg, S., Curcio, C. A., Bird, A. C., Blodi, B. A., Bottoni, F., Chakravarthy, U., Chew, E. Y., Csaky, K., Danis, R. P., Fleckenstein, M., Freund, K. B., Grunwald, J., Hoyng, C. B., Jaffe, G. J., Liakopoulos, S., Monés, J. M., Pauleikhoff, D., … Staurenghi, G. (2018). Consensus Definition for Atrophy Associated with Age-Related Macular Degeneration on OCT: Classification of Atrophy Report 3. Ophthalmology, 125(4), 537–548. https://doi.org/10.1016/j.ophtha.2017.09.028

  5. Tian, B., Al-Moujahed, A., Bouzika, P., Hu, Y., Notomi, S., Tsoka, P., Miller, J. W., Lin, H., & Vavvas, D. G. (2017). Atorvastatin Promotes Phagocytosis and Attenuates Pro-Inflammatory Response in Human Retinal Pigment Epithelial Cells. Scientific reports, 7(1), 2329. https://doi.org/10.1038/s41598-017-02407-7

  6. Vavvas, D. G., Daniels, A. B., Kapsala, Z. G., Goldfarb, J. W., Ganotakis, E., Loewenstein, J. I., Young, L. H., Gragoudas, E. S., Eliott, D., Kim, I. K., Tsilimbaris, M. K., & Miller, J. W. (2016). Regression of Some High-risk Features of Age-related Macular Degeneration (AMD) in Patients Receiving Intensive Statin Treatment. EBioMedicine, 5, 198–203. https://doi.org/10.1016/j.ebiom.2016.01.033
     

Learning Objectives:

  1. To understand the appearance of geographic atrophy on OCT and the reasoning behind it

  2. To recognize the management options of geographic atrophy