Diagnosis and Management of a Bilateral Macular Problem

A 59‐year‐old gentleman presented with decreased visual acuity and metamorphopsia in both eyes for one year, worsening over the past three months. Except for a history of phacoemulsification and intraocular lens (IOL) implantation in his left eye, medical, surgical and ocular history was unremarkable. Best corrected visual acuity was 3/10 and 6/10 with +3.50‐0.75 × 180 and −0.50‐0.75 × 180 in the right and left eyes, respectively. There was no relative afferent pupillary defect. Slit lamp examination revealed 2 + nuclear sclerosis (NS) and 2 + posterior subcapsular (PSC) cataract in the right eye and a well‐positioned posterior chamber IOL (PCIOL) in his left eye. Intraocular pressure was 18 mmHg in both eyes. On the fundus examination, the media were clear and the optic discs had normal appearance. Vertical cup‐to‐disc ratio was about 0.4 in both eyes. Figures 1‐4 show color fundus photography, optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green (ICG) angiography images of both eyes, respectively. Question 1: How do you explain findings evident on the fundus photograph [Figure 1a and b], OCT [Figure 2a and b], FA [Figure 3a and b] and ICG [Figure 4a and b]? Question 2: What is your diagnosis according to the findings? Question 3: What are the differential diagnoses? Question 4: What is your plan for this patient? Question 5: What is the importance of Enhanced Depth Imaging (EDI) findings [Figure 2]? Diagnosis and Management of a Bilateral Macular Problem