Question

A 70-year-old male presents with central unilateral metamorphopsia. What is the differential diagnosis?

Hint:

Unilateral central metamorphopsia in a patient over 50 years of age is often associated with age-related macular degeneration (AM and requires urgent evaluation.

Answer 1

Step 1: Differential Diagnosis of Central Unilateral Metamorphopsia.
Metamorphopsia refers to the visual distortion of objects, such that straight lines appear wavy or distorted. In a 70-year-old male with central unilateral metamorphopsia, the differential diagnosis includes the following conditions:
(1) Age-Related Macular Degeneration (AM:
- AMD, particularly wet AMD, can cause central vision distortion and metamorphopsia. It results from choroidal neovascularization, leading to macular edema and scarring.
(2) Macular Edema:
- Diabetic macular edema or macular edema due to retinal vein occlusion can cause central vision distortion due to fluid accumulation in the macula.
(3) Macular Hole:
- A macular hole may cause a central scotoma or metamorphopsia due to structural damage in the fovea.
(4) Epiretinal Membrane (ERM):
- The presence of an ERM can lead to macular distortion and central vision problems, often causing metamorphopsia.
(5) Central Serous Retinopathy (CSR):
- CSR leads to fluid accumulation under the retina, resulting in distorted or blurred vision, often with a characteristic yellow subretinal lesion.
(6) Retinal Vein Occlusion (RVO):
- RVO can cause sudden vision changes and central retinal edema, leading to metamorphopsia.