History/Chief Complaint
• A 46-year-old white male presents with blurred vision while reading as well as increased difficulty with virtually all near tasks. He reports a family history of glaucoma and his last eye exam, about a decade earlier, was uneventful.
Clinical Findings
• BCVA 20/20 +2 OD and OS. J3 at near OU.
• External WNL.
• Goldmann IOPS 18/18.
• Refraction plano OU at distance.
• +1.50 OU at near with JI VA OD and OS.
• Amsler grid: subtle distortion inferior temporal to fixation OS greater than OD.
• DFE: normal discs and scattered light color specks nasal to the fovea OU.
• FAF: some hypoautofluorescence spots OU outside of the macula.
• Wide field imaging: scattered subtle defects, likely at the level of the RPE OU.
OCT Image
• SD OCT: disruption of the PIL and RPE superior nasal to the fovea OLJ. Scattered mild elevation Of the RPE possibly due to underlying drusen like deposits OD.
Repeat and Expanded History
• The patient recalls subtle vision blur in each eye immediately following a very stressful episode one week after the birth of his twin boys 13 years earlier. A C-section was performed at 29 weeks and hence his boys were born about 10 weeks premature. About a week atter the birth, his wife’s vertical incision spontaneously opened due to staple failure. He rushed his wife to the hospital and actually assisted the surgeon in re-stapling the opened incision. The husband never bothered to have his eyes examined after the episode since his central vision was never compromised.
Diagnosis
• Probable stress related central serous chorioretinopathy OU 13 years earlier. Residual change at the level of the RPE present with permanent loss of the PIL resulting in permanent Amsler grid abnormalities.