This 69YO male has stable vision loss in his left eye from an age-related disciform scar.
Optos color RGB imaging shows massive subretinal fibrosis occupying virtually the entire macula, which extends into the inferior midperiphery. Optos Silverstone OCT shows markedly thickened hyperreflective subretinal fibrosis. Vision was remarkably 20/400. Continued observation was recommended.
Learning Points:
Disciform scars were the norm for untreated neovascular AMD (nAMD) prior to the anti-VEGF era that began in the mid-2000s. New-onset nAMD diagnosed and treated with timely anti-VEGF dosing virtually never goes on to develop these lesions. There may be progressive macular atrophy following years of therapy, but not this type of fibrotic scarring.
For an extensive discussion on the SD-OCT findings of these age-related fibrotic lesions, see the AOS thesis by Souied et al (AJO 2020;214:151-171).
