The patient was diagnosed with a subretinal neovascular membrane surrounded by hemorrhages in the left eye. The patient was treated urgently using krypton laser. Following a recurrence, the patient was treated again in the same way a few weeks later.

Since then, the patient has been followed-up regularly by a specialist and has had fluorangiography tests.

After 10 years, having experienced slight metamorphopsia associated with further myopic progression, the patient’s regular fluorangiography test carried out and revealed subfoveal choroidal neovascularization in his right eye. The patient received photodynamic therapy with Visudyne and laser photoactivation.

The follow-up visit and fluorangiographic examination carried out and confirmed that treatment was successful.

However, the patient has reported to his attending ophthalmologist that he has experienced more accentuated metamorphopsia with greater difficulty reading medium to large characters (accentuated distortions) and stable, or improved, reading of small or very small characters (absence of lifting effect), although always with immense effort and difficulty.

Questions:

1) Is the therapy received to date correct?

2) Is PDT therapy the only useful treatment in this case, or should other therapeutic/surgical options be considered?

3) Are there any private or public healthcare facilities, including international ones, specialized in research and treatment of myopic macular degeneration, including experimental therapies?

4) Can you provide any suggestions about lifestyle and any other precautions that can be taken, or advice concerning optical and electronic devices for the partially-sighted?

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:

At your request, I have reviewed the above referenced case and I will provide an opinion based solely on my review of the provided case details. The patient has a history of high myopia with subsequent macular neovascularization in both eyes. His left eye became affected requiring krypton laser treatment and the right eye recently suffered similar neovascularization. He was evaluated with a fluorescein angiogram and received PDT treatment using Visudyne and laser photoactivation . He continues to experience progressive symptoms of metamorphopsia and difficulty reading. I think that the therapy was appropriate to date, however, he is a good candidate for Lucentis or Avastin intravitreal injections into the right eye in attempt to halt the neovascularization and leakage of fluid under the retina.

The intraocular injections can be performed by any retina specialist anywhere in the world. This is becoming the standard of care treatment for neovascularization of the macula.

Please let me know if I can provide any additional clarification of this case.

I would be happy to arrange for one of our retina specialists in my practice to see this patient if he wishes to travel to the United States. If we can be of any further help to you, please contact me, through Medical Opinion.

Thank you,

Sincerely,

Prof.