The patient was a 73-year-old man with a history of wet AMD in the left eye for which he had been receiving anti-VEGF treatments for three years. He presented with decreased vision in the right eye for two weeks. The visual acuity had fallen from 20/20-2 to 20/25-3. The anterior segment examination was remarkable for mild nuclear sclerotic cataracts in each eye. The posterior segment was remarkable for drusen in the right macula and subretinal fibrosis in the left macula.
This case illustrates the utility of OCT angiography (OCTA). Single cuts with spectral domain OCT shows thickening above the RPE, suggesting choroidal neovascular membrane (CNV) formation, but there is no clear subretinal fluid. OCTA shows a CNV at the level of the RPE/neurosensory retina. Because the patient had symptomatic loss of vision, we initiated anti-VEGF treatment.