A 63-year-old man presented to the Wills Eye General Ophthalmology clinic for a routine examination. He noted “blurred vision” in the right eye for three months. He had uncomplicated cataract extraction and posterior chamber intraocular lens implantation two years prior in both eyes with good visual outcome. The blurred vision was gradual in onset and painless.
The patient had a history of hypertension controlled with hydrochlorothiazide. There was no alcohol or tobacco use. A family history of glaucoma (mother), breast cancer (mother), diabetes (father), and coronary heart disease (father) was noted. The review of systems was otherwise negative.
Six months prior, the patient had best-corrected visual acuity of 20/30 OU with a mildly myopic prescription. At this visit, the BCVA in the left eye was 20/30 with no refractive change, but the right eye was 20/50 with a hyperopic shift of 1.5 D. Examination of pupillary reactions, visual fields, ocular motility and intraocular pressures were normal OU.
The anterior segment examination was normal OU. Intraocular lenses were centered OU. The posterior examination was normal OS. Examination of the right fundus revealed a large, slightly raised yellow subretinal lesion temporal to the fovea and extending peripherally (See Figure 1).
What is your differential diagnosis? What further workup would you pursue?