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

F. Ryan Prall, MD


September 24, 2021

The workup for AMD should begin with all routine approaches of the traditional medical eye evaluation (thorough dilated examination of the fundus with slit lamp biomicroscopy; stereo color photography of the fundus). In addition, imaging modalities such as optical coherence tomography (OCT), fundus fluorescein angiography, and OCT angiography provide diagnostic value for suspected AMD.

As opposed to other imaging modalities, OCT can define the cross-sectional architecture of the retina. OCT can also detect subretinal and intraretinal fluid, and, in allowing clinicians to identify structural changes of the retina and choroid, offers value in continuous monitoring and measuring response to therapy. Newer modalities, such as spectral domain OCT, are preferred. Biomicroscopy alone cannot reveal fluid presence as OCT can.

In general, fluorescein angiography is indicated to determine the cause of unexplained visual loss or metamorphopsia. Other signs and symptoms that should prompt its use include elevation of the RPE or retina, macular edema, subretinal blood, hard exudates, or subretinal fibrosis; or, when the OCT shows evidence of fluid. Fluorescein angiography also detects and characterizes CNV and can serve as a monitoring tool to detect persistent or recurrent CNV or other retinal diseases.

The value of microperimetry and adaptive optics have yet to be determined in the setting of AMD. The value of indocyanine green angiography has been the subject of debate in patients with suspected AMD, and this modality also carries potentially serious risks.


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