Decreased Vision on Routine Eye Exam

Bisant A. Labib, OD; Case Series Editor: Jean Marie Pagani, OD


November 04, 2015

Clinical Presentation

An 80-year-old black woman presented to the clinic for a routine eye examination. Her previous eye examination was about 2 years ago, when she underwent cataract extraction with intraocular lens implantation in the left eye only. Shortly after her surgery, she received a bifocal pair of spectacles, which she wore to her examination.

Her systemic history was remarkable for hypertension for 10 years that was under control with carvedilol. She also had seasonal allergies that were controlled with over-the-counter medicine as needed.

Examination findings included the following:

  • Best-corrected visual acuity was 20/20 for the right eye, 20/70 for the left eye

  • Pupils were isocoric, round, and reactive to light, with no afferent pupillary defect

  • Extraocular muscle movements were full, with no restrictions in both eyes

  • Confrontation visual fields were full to finger-counting in both eyes

  • Slit-lamp examination showed clear conjunctiva, corneal arcus, formed and quiet anterior chambers, and flat irises in both eyes

  • Intraocular pressures using Goldmann applanation tonometry were 15 mm Hg for both eyes

Dilated fundus examination revealed early nuclear sclerotic changes in the right eye and a posterior chamber intraocular lens implant in the left eye that was clear and well-centered. The vitreous of both eyes were clear. The retina was flat and intact 360° in both eyes. Cup-to-disc ratios were 0.30/0.30, with healthy and perfused rims in both eyes. The macula in the right eye was flat and intact, but the macula in the left eye was minimally elevated, with overlying pigmentary changes (Figure 1).

Figure 1. The macula of the right eye is flat and dry. The left eye shows elevation and a loss of foveal depression, with intraretinal cystic pockets and a central macular thickness of 525 µm compared with a macular thickness of 274 µm in the right eye.


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