A 44-year-old Caucasian female presented to Wills Eye complaining of blurred vision in the right eye with mild worsening of vision over the past four months. She believed that her symptoms were related to seasonal allergies. She denied pain, diplopia, field loss, metamorphopsia, flashes or floaters.
The patient denied any prior ocular or significant systemic medical history, and took no medications. She noted a family history of prostate, bladder, lung and pancreatic cancer.
Ocular examination revealed visual acuity in the right eye without correction of 20/30+2 without pinhole improvement and 20/20 in the left eye. Pupils were reactive without a relative afferent pupillary defect. Ocular motility in both eyes was full and there were no visual field defects on confrontational testing. Applanation tonometry measured an intraocular pressure of 18 mmHg in the right eye and 17 mmHg in the left eye.
Slit-lamp examination revealed an unremarkable external, adnexal and anterior segment in both eyes. Exam of the posterior pole of the right eye was remarkable for an epiretinal membrane with retinal striae, macular edema and early neovascularization of the optic disc (See Figure 1). Posterior exam of the left eye was unremarkable. Optical coherence tomography was performed, showing the ERM with cystoid macular edema in the right eye, and a normal left eye (See Figure 2).
What is your differential diagnosis? What further workup would you pursue?