This lady attended for a routine appointment. She was complaining of deteriorating vision in her Right eye. She has mild cataract and had booked in for a silver appointment. On examination her acuity vision was reduced by 2 lines, and the mild cataract which prevented a decent view with the hand held instrument, and nothing could be seen. I explained that the cataract prevents a good view and that an OCT scan would be beneficial to rule out any problems. She agreed to upgrade.
Retinal photo is shown which shows a central darker patch and some striations on the surface. The OCT thickness map shows a tear shaped thick area and overall thickness is in the pink 4 percentile. The retinal B-Scan speaks for itself. there is an epiretinal membrane on the surface which is tightening up and has lifted the top half of the macula area to form a partial thickness hole. Had I carried out a Bronze examination it would have been easy to put the vision loss down purely to the cataract. A silver does show some changes but the Gold level scan comes into its own. When looking at the other eye the retinal photo looks normal, the OCT thickness map shows some thickening and the OCT Gold scan shows that there is the start of an epiretinal membrane and the Left macula is slightly distorted as the membrane just starts to tighten.
This lady was referred and after much discussion with the consultant and the risks of surgery she decided to wait and allow us to monitor the situation as her other eye is still very good.