A 60 year old male, smoker, presented to my office the other week with complaints of acute vision loss in the left eye.  Past medical history was not contributory.  There was no history of valsalva.  Physical exam included a normal exam of the right eye and a dense submacular hemorrhage of the left eye.  Fluorescein angiography did not reveal evidence of choroidal neovascularization.  Would you consider intravitreal injections (anti-VEGF of your choice) now or when in the future?  If the right eye showed drusen and some pigmentary changes, would this alter your decision of treating?

This is a real patient of mine.  I have elected to follow him, have no evidence of CNV, but suspect he may require an injection (I prefer Avastin) in the near future.  I see him weekly.

How about you?

Randall V. Wong, M.D.
www.TotalRetina.com ^[1]