Sunday, September 24, 2023
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Director of Research
The University of Sydney Save Sight Institute
Faculty of Medicine and Health
Sydney Hospital
Sydney, Australia
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Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 1.00 ABIM MOC points
This educational activity is intended for an international audience of non-US ophthalmologists, eye-care professionals, and all physicians who care for patients with signs and symptoms of age-related retinal disease.
The goal of this activity is for learners to be better able to assess the origins of retinal atrophy, predict progression, and prepare for future treatment options.
Upon completion of this activity, participants will:
Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.
Director of Research
The University of Sydney Save Sight Institute
Faculty of Medicine and Health
Sydney Hospital
Sydney, Australia
This activity has been peer reviewed and the reviewer has no relevant financial relationships.
Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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Approved by The Royal College of Ophthalmologists for 1.0 CPD point.
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CME / ABIM MOC Released: 4/28/2023
Valid for credit through: 4/28/2024, 11:59 PM EST
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The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short posttest assessment based on the material presented.
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A 78-year-old man, Peter, is referred to you by his optometrist because of mildly reduced visual acuity, mild functional visual impairment and zones of atrophy surrounding the fovea in both eyes. Peter reports difficulty reading in low light, saying that "the words are jumbling sometimes and suddenly appear and disappear." He is active and fit for his age, though he has a history of tobacco use and has been treated for benign prostatic hyperplasia. His mother lost vision from age-related macular degeneration (AMD) in her 80s. His visual acuity is 6/9 in both eyes, and spectral-domain optical coherence tomography (SD-OCT) shows regions of signal hypertransmission into the choroid of > 250 microns with associated retinal pigment epithelium (RPE) loss.
Imaging. Peter's color fundus photography, fundus autofluorescence (FAF) images and optical coherence tomography (OCT) images show multifocal lesions surrounding the fovea in both eyes (Figures 1, 2, and 3).
Figure 1. Color Fundus Photography
Color fundus photographs show crystalline (regressing) medium-sized drusen temporally with zones of atrophy in which the large choroidal vessels are seen more clearly in both eyes (images courtesy of Emily Luu).
Figure 2. Fundus Autofluorescence
FAF shows hypofluorescence corresponding to RPE loss encircling the fovea in both eyes and almost completely in the right eye. The regressing drusen are moderately hyperautofluorescent. There is also hyperautofluorescence of the lesion boundaries, which is more pronounced along the outer than the foveal-facing borders (images courtesy of Emily Luu).
Figure 3. OCT Imaging
OCT shows increased penetration of the signal into the choroid in zones corresponding to the atrophy seen on FAF imaging. Subretinal debris is seen elsewhere, and there are also multiple hyper-reflective dots in the outer nuclear layer of the left eye (bottom image) (images courtesy of Emily Luu).
