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

F. Ryan Prall, MD


September 24, 2021

Based on the patient's physical examination, it would appear that his diagnosis can be further classified as intermediate AMD, which is characterized by presence of either multiple intermediate drusen or at least one druse 125 μm in diameter or greater; and atrophy of the RPE (not involving the foveal center). Early AMD, by contrast, is characterized by a combination of multiple small drusen, few intermediate drusen (63-124 μm in diameter), or mild RPE abnormalities. Advanced AMD is characterized by atrophy of the RPE that does involve the foveal center in at least one eye. A disciform scar, which is the end stage of exudative AMD, would announce itself as hyperfluorescent on fluorescein angiography. 

Neovascular AMD, a form of advanced AMD, is characterized by CNV (defined at this stage as pathologic angiogenesis arising from the choroidal vasculature and extending through a defect in Bruch membrane); serous and/or hemorrhagic detachment of the neurosensory retina or RPE; retinal hard exudates (the result of chronic vascular leakage); subretinal and sub-RPE fibrovascular proliferation; or disciform scarring.


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