CLINICAL INFORMATION

Patient: 69 year old female

Diagnosis: Bilateral colloid degeneration

Case history:

The remote pathological analysis identifies the following (dates have been removed to protect confidentiality):

- Cholecystectomy for biliary lithiasis;

- Surgical intervention for Adenocarcinoma of the colon with subsequent chemotherapy and radiotherapy;

- Laparoscopic lysis of abdominal adhesions;

- For approximately 1 year, diagnosis of depressive syndrome treated pharmacologically;

- Diagnosis of Type 2 diabetes mellitus during admission for suspected intestinal blockage;

- Myopia for approximately 20 years.

Home treatment - medications:

- Tavor 2.5 mg, dosage: 1 cp a day for approximately 20 years;

- Xanax 0.5r mg, dosage: 1 cp a day for approximately 3 years;

- Stilnox, dosage: 1 cp a day for approximately 10 years;

- Zoloft 50 mg, dosage: 1 cp a day for approximately 3 years;

- Glicazide 80 mg, dosage: 1 cp a day for approximately 1 year.

Following the appearance 6-8 months ago of visual disturbances described as “dark spots” and a reduced perception of luminosity in the visual field, as well as a burning sensation at the sides of the eyes, a specialist ophthalmologic examination was undergone.

The examination of the ocular fundus carried out during this consultation did not indicate any ophthalmoscopic signs of diabetic retinopathy, but rather colloid degeneration for which a fluorangiographic examination was advised, carried out on ---(enclosed) confirming the diagnosis of colloid degeneration.

Questions:

1) Is there a surgical and pharmacological therapy able to resolve the problem?

2) Would a pharmacological therapy be compatible with the patient’s diabetes?

3) Could the illness in question deteriorate to the point where the patient

loses her sight?

 

Medical Report:

Dear Dr.:

Thank you for the referral and the copy of the medical records for this patient.I had the opportunity to review the patient’s medical records:

This second opinion is based on the attached clinical information of the patient submitted to me (Please see below). I have not examined the patient and my opinion is based solely on the very limited information provided.

The patient is a 69 year old female with a diagnosis of Bilateral Colloid Degeneration.

According to the submitted material the remote pathological analysis and past medical history includes:

- Cholecystectomy for biliary lithiasis;

- Surgical intervention for adenocarcinoma of the colon with subsequent chemotherapy and radiotherapy in ---;

- Laparoscopic lysis of abdominal adhesions in ---;

- Depressive syndrome treated pharmacologically for approximately 1 year

- Type 2 diabetes mellitus during admission for suspected intestinal blockage, in ---;

- Myopia for approximately 20 years.

Her current medical therapy includes:

- Tavor 2.5 mg at the dosage of 1 cp a day for approximately 20 years;

- Xanax 0.5r mg at the dosage of 1 cp a day for approximately 3 years;

- Stilnox at the dosage of 1 cp a day for approximately 10 years;

- Zoloft 50 mg at the dosage of 1 cp a day for approximately 3 years;

- Glicazide 80 mg at the dosage of 1 cp a day for approximately 1 year.

The past Ophthalmological history began about 6 to 8 months ago with symptoms of dark spots and reduction of perception of luminosity in the visual field. No information is provided as to whether these symptoms were in one eye or in both eyes. She also had complaints of a burning sensation on the sides of both eyes.

Unfortunately no information is provided on the visual acuity in both eyes of the patient or the evaluation of the retina and vitreous. Dark spots can be produced by a posterior vitreous detachment or retinal tears or haemorrhages. In particular, a haemorrhage would be worrisome in a patient that has diabetes mellitus. I would surmise that none of these findings were present at the time of her last examination by an Ophthalmologist.

On ---, the patient was examined by an Ophthalmologist specialist. According to that exam no evidence of diabetic retinopathy was reported but Colloid degeneration was noted. A Fluorescein Angiography performed on ---, confirmed the presence of Colloid Degeneration.

I have reviewed the angiogram that was submitted with the patient´s history. The Monochromatic photographs provided show extensive large and confluent drusen in both eyes, consistent with the diagnosis of dry age related macular degeneration. The fluorescein angiographic photos show in both eyes round, well demarcated areas of hyperfluorescense corresponding to the drusen that are typically seen in this condition.

Drusen are white deposits seen in the macula of patients that have age related macular degeneration. They indicate a higher risk of development of the Wet or Neovascular type of age related macular degeneration.

There is today a pharmacological therapy that is given to patients with dry age related macular degeneration. I would suggest that the patient be started on Ocuvite Preservision, 1 gelcap twice daily. This regimen of vitamins and minerals has been shown by the AREDS study to reduce the risk of severe visual loss from this condition by more than 30%.

I do not have information on the smoking status of the patient. Current smokers and prior smokers should probably avoid the high doses of beta carotene contained in the AREDS Ocuvite Preservision gelcaps because elevated beta carotene supplementation increases somewhat the risk of lung cancer in smokers. For patients with a smoking history I recommend Ocuvite Lutein, 1 tablet two times a day, since this contains much smaller amounts of beta carotene.

This suggested therapy is compatible with the patient’s diabetes mellitus.

The patient should check her vision in each eye with an Amsler grid test. Any changes in the perception of this test or any blurriness of vision or distortion of straight lines should prompt the patient to seek an eye evaluation, as soon as possible.

Patients with dry age related macular degeneration can have deterioration of vision, and therefore, a close follow up by an ophthalmologist is important. Patients with dry age related macular degeneration can develop the wet type of this condition in which blood vessels grow under the center of the vision leading to a decrease in vision.

Early detection of the wet type of this disease is important because we have new treatments with eye injections and laser therapy that can prevent vision loss. This is one of the reasons why regular and prompt eye examinations are important.

Although age related macular degeneration can significantly decrease the central vision, it never causes complete blindness.

I would be happy to see this patient in my practice if she wishes to travel to the United States. If we can be of any further help to you, please contact ---, through Medical Opinion.

Thank you.

Sincerely,