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Neurology

Metamorphopsia in a Middle-aged Man

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Ophthalmology

Published Online: July 15, 2021

JAMA Ophthalmology Clinical Challenge

Article Information and Disclosures

Benjamin J. Fowler, MD, PhD¹;

Jimmy L. Nguyen, OD¹;

Jayanth Sridhar, MD¹

Author Affiliations

¹Bascom Palmer Eye Institute, University of Miami, Miami

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A 47-year-old man presented with gradual onset of blurry vision in both eyes for several months. Best-corrected visual acuity was 20/20 OD and 20/40 OS. Intraocular pressure was 23 mm Hg in both eyes and was more than 21 mm Hg in both eyes on multiple visits. Medical history included hypertension, obesity, left adrenalectomy, and pterygium excision surgery in the left eye. The patient denied previous episodes of blurry vision, history of corticosteroid use, sleep apnea, or type-A personality. Complete review of systems was otherwise negative. Amsler grid testing revealed paracentral metamorphopsia in both eyes. Extraocular motility, pupillary light reactions, and confrontational visual fields were normal. Slitlamp examination and gonioscopy results were normal in both eyes. An external photograph of the patient is shown in Figure 1A. Fluorescein angiography demonstrated multiple areas of late pinpoint leakage and patches of mottled hyperfluorescence in both eyes (Figure 1B).

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A 47-year-old man presented with gradual onset of blurry vision in both eyes for several months. Best-corrected visual acuity was 20/20 OD and 20/40 OS. Intraocular pressure was 23 mm Hg in both eyes and was more than 21 mm Hg in both eyes on multiple visits. Medical history included hypertension, obesity, left adrenalectomy, and pterygium excision surgery in the left eye. The patient denied previous episodes of blurry vision, history of corticosteroid use, sleep apnea, or type-A personality. Complete review of systems was otherwise negative. Amsler grid testing revealed paracentral metamorphopsia in both eyes. Extraocular motility, pupillary light reactions, and confrontational visual fields were normal. Slitlamp examination and gonioscopy results were normal in both eyes. An external photograph of the patient is shown in Figure 1A. Fluorescein angiography demonstrated multiple areas of late pinpoint leakage and patches of mottled hyperfluorescence in both eyes (Figure 1B).

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Article Information

Corresponding Author: Jayanth Sridhar, MD, Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136 (jsridhar1@med.miami.edu).

Published Online: July 15, 2021. doi:10.1001/jamaophthalmol.2020.7095

Conflict of Interest Disclosures: Dr Sridhar reported personal fees from Alcon, DORC, Oxurion, and Regeneron Pharmaceuticals. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.