History/Chief Complaint

  • A 46 year old Hispanic high school math teacher presented for follow-up for Stargardt’s macula degeneration diagnosed decades earlier and normal tension glaucoma more recently detected. One sister had Stargardt’s macula degeneration and another had glaucoma. Alphagan TID OU, Travatan qhs OU and two selective laser trabeculectomies (SLTs) OU have recently lowered IOPs to below the target pressure of 14 OU.

Clinical Findings

  • BCVA 10/400 OD and OS.
  • Fundus exam: Approx .65 C/D ratio OD and .8 CD ratio with inferior temporal notch OS. Large macula lesions OU with a “bronze beaten” appearance with pigment atrophy and hypertrophy. Numerous white-yellow deep retinal lesions or “flecks” occupy much of the fundus but not the far periphery OU.
  • Ta = 11/11 at 3:00PM.

Cirrus™ HD-OCT

  • Loss of outer retinal layers secondary to Stargardt and loss of the retinal nerve fiber layer secondary to glaucoma.
  • The photoreceptor integrity line (PIL) (see page 11) is absent in the macula and quite attenuated in other zones.

Diagnosis

  • Stargardt’s Macula Dystrophy with Fundus Flavimaculatus OU.
  • Normal tension glaucoma OU.

Treatment

  • None available for Stargardt and continue with present treatment for glaucoma.