History
- Decreased visual acuity, blurred vision, metamorphopsia, micropsia, dyschromatopsia
- Steroid therapy (systemic, inhaled, topical, injections), sympathomimetics, stress, type A personality)
Differential Diagnosis
- AMD, optic pit, choroidal tumors, hypertensive retinopathy
Diagnostics
- RAPD
- Amsler grid (metamorphopsia, relative central scotoma)
- Subjective visual acuity
- Fundus examination under mydriasis (choroidal tumors)
- OCT of the macula and optic disc and photographs (central/multifocal subretinal fluid, hyporeflective PEDs, RPE remodeling, secondary CNV/double-layer sign)
- FA (leakage point)
Prognosis
Good prognosis at first presentation
Worse prognosis with recurrences and retinal remodeling
Management
First presentation, symptoms for 3-4 months > observe
- Letter to primary care physician/rheumatologist/ENT specialist/orthopedist if applicable, asking about switching to steroid-sparing therapy
- Discuss stress-reduction measures if applicable
- Letter to primary care physician if applicable for blood pressure check and cortisol level (suspected Cushing's disease), Helicobacter pylori
Follow-up after 4 weeks with OCT of the macula and optic disc and photographs
Treatment
If no improvement
- FA (leakage point)
- If eccentric (> 500 μm from the fovea) > focal argon laser coagulation
- CNV > anti-VEGF (cost coverage approval required for Lucentis)
- Referral to a tertiary center for photodynamic therapy (PDT) with half-dose verteporfin (Visudyne), if applicable
- Therapy with spironolactone (eplerenone) > lacking clinical evidence (Lotery A et al, The Lancet 2020)
Will's Eye Manual, Blaubuch Inselspital
