Skill Checkup: A 61-Year-Old Man With Central Visual Acuity Blurring

F. Ryan Prall, MD


September 24, 2021

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 61-year-old man presents with painless progressive blurring of central visual acuity with an acute onset. He is a nonsmoker who has undergone a hip replacement but has no significant comorbidities. He reports that lately he has been having difficulty reading and explains that driving lanes appear crooked, describing other items as "distorted" or "warped" in his visual field. He fears that he is developing a "blind spot." His peripheral vision, however, is undisturbed.

The patient does not routinely undergo eye examinations because he usually buys his eyeglasses at the convenience store whenever his current prescription runs its course. He does not have complaints in regard to any other systems. His height is 5'9" and weight is 180 lb.

Amsler grid testing reveals a central scotoma and metamorphopsia. Drusen of 128 μm are seen during a dilated eye examination. Atrophy of the retinal pigment epithelium (RPE) is seen, although it does not involve the center of the fovea. Effects are asymmetric, but both eyes show subretinal fluid. Choroidal neovascularization (CNV) and subretinal hemorrhage is seen at the margins of the CNV.


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