Dear All,
Please give me your thoughts on this case.
77 y.o. lady with progressive glare and blurry vision over the last 9 months. She had successful cataract surgery OU in 2021 with monofocal lenses and was thrilled with the results (20/20 OD and 20/25 OS) until November 2024 when she started to note glare and blur.
No eye pain, no headache. No improvement with artificial tears. In February 2025 she stopped driving.
PMH: hypercholesterolemia and dry eye.
Meds: atorvastatin, tears
SH: no drugs. Social drinker.
Seen by cornea in 1/2025 and vision was 20/40 OD and 20/150 OS PH 20/40 OD and 20/50 OS. There is mild PCO but not enough to explain her vision loss. With refraction she is 20/40 OD and 20/70 OS, 20/30 at near OU. HVF 24-2 with non specific changes
Sees me in 3/2025 and subjectively vision is worse, but objectively unchanged, 20/50 OD and 20/150 OS, PH 20/40 OU.
Her color vision is down 6/11 OD and 1/11 OS. Her nerve looks healthy. HVF 24-2 subtle paracentral changes. OCT RNFL full and normal OU in 3/2025 and again in 6/2025. OCT Mac with central cystic changes OD that retina thinks represents foveoretinoschisis, but it does not explain the vision changes. Normal FA. Normal ERG. Normal MRI brain/orbit. Normal basic labs (B vitamins, ESR, CRP, CBC, syphilis)
Saw her again this week and she thinks the vision is even worse, but it's testing exactly the same (20/40 by PH OU, and PAM is 20/40 OU). I can get her color to 7/11 OU and Farnsworth Munsell 15 has a few neighboring color confusion. Her HVF 24-2 was grossly normal. 10-2 subtle central changes OS>OD.
Curious what more you would test given the normal structural studies. Cotnea faculty says this is not the PCO. Retina faculty says it's not the foveoretinoschisis. Genetic? Functional? She is adamant that she cannot see or function due to blur and glare.
Thanks!
Peter.
Peter MacIntosh, MD | He/him/his
Associate Professor
Director Ophthalmology Residency Program
Director Neuro-Ophthalmology Service
Director Global Ophthalmology Fellowship
Illinois Eye and Ear Infirmary
UIC Department of Ophthalmology and Visual Sciences
T: 312.996.9120 | F: 312.413.7895 | pmacint1@uic.edu
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