Blue Sclera posted recently about trying to make this msg board more clinical and given that it seems like we have some very knowledgable retina specialists here, I'll present a case that comes up often and I'd like to see they'd do:
Suppose you have an elderly patient with end-stage wet AMD in one eye. He has had several years of 20/400 or counting fingers vision in one eye with a fibrotic macular scar and overlying loss of the ellipsoid zone. At the edge of the scar you see a new >1DD sub-retinal hemorrhage in a pretty extra-foveal location. What would you advise the patient?
On one hand this patient has no prospect of central vision improvement. On the other hand his central scotoma might enlarge if he hemorrhages more or he may get a vitreous hemorrhage blocking out his peripheral vision.
Would you offer monthly anti-VEGF injections until the heme clears? PDT? Thermal laser? Or rec: observation?
If you chose injections -- What if the patient does not want monthly injections if they have poor vision and no prospect of vision improvement, as many patients don't? Would you do PDT or thermal? Do you think one mode of laser treatment is much better than the other in this scenario?
What if the patient is on a strong blood thinner: coumadin, pradaxa, eliquist, xarelto, etc.. would that change your recommendation?
Thanks for the posts!
Suppose you have an elderly patient with end-stage wet AMD in one eye. He has had several years of 20/400 or counting fingers vision in one eye with a fibrotic macular scar and overlying loss of the ellipsoid zone. At the edge of the scar you see a new >1DD sub-retinal hemorrhage in a pretty extra-foveal location. What would you advise the patient?
On one hand this patient has no prospect of central vision improvement. On the other hand his central scotoma might enlarge if he hemorrhages more or he may get a vitreous hemorrhage blocking out his peripheral vision.
Would you offer monthly anti-VEGF injections until the heme clears? PDT? Thermal laser? Or rec: observation?
If you chose injections -- What if the patient does not want monthly injections if they have poor vision and no prospect of vision improvement, as many patients don't? Would you do PDT or thermal? Do you think one mode of laser treatment is much better than the other in this scenario?
What if the patient is on a strong blood thinner: coumadin, pradaxa, eliquist, xarelto, etc.. would that change your recommendation?
Thanks for the posts!