A 69-year-old man comes to the office due to progressive bilateral loss of vision over the past several months. He only has problems with his central vision. His peripheral field and navigational vision are not affected. He does not use tobacco or alcohol. The patient does not have a history of diabetes or hypertension. Two years ago, he had cataracts removed from both eyes. What is the most likely diagnosis?

Question

A 69-year-old man comes to the office due to progressive bilateral loss of vision over the past several months.  He only has problems with his central vision.  His peripheral field and navigational vision are not affected.  He does not use tobacco or alcohol.  The patient does not have a history of diabetes or hypertension.  Two years ago, he had cataracts removed from both eyes.  What is the most likely diagnosis?

Quizplus · Accepted Answer

Age-related macular degeneration (AMD) is usually seen in patients age >50. It presents with progressive and bilateral loss of central vision. Peripheral fields and navigational vision (allowing patients to navigate around obstacles in their surroundings and maintain social independence) are classically maintained, although they may become impaired due to the development of cataracts. AMD results from degeneration and atrophy of the central retina (macula), retinal pigment epithelium, Bruch's membrane, and choriocapillaries. (Choice A) Open-angle glaucoma usually presents as a gradual loss of peripheral vision (over a period of years) and consequent tunnel vision. Central vision is spared. (Choice C) Once removed, cataracts do not typically recur. Following cataract surgery, some patients develop posterior capsule opacification (thickening of the capsule holding the artificial lens), which can cause cloudy vision and can be treated (eg, with laser) without resulting in longterm vision problems. Progressive central vision loss with maintenance of peripheral vision is highly suggestive of AMD. (Choices D and E) Central retinal artery occlusion and retinal detachment are very acute conditions with complete vision loss. Educational objective: Age-related macular degeneration is usually seen in patients age >50. It presents with progressive and bilateral loss of central vision. Navigational vision is preserved.

A 69-Year-Old Man Comes to the Office Due to Progressive