This patient with age-related macular degeneration (AMD) has a large fibrotic disciform scar in the right eye and dry AMD in the left eye with macular atrophy skirting the foveal center and more distal calcified drusen.
The coarse pigmentary changes noted inferiorly and temporally in the right eye are a classic tell-tale finding for prior resolved subretinal blood (see Hussnain et al Retina 2019;39:1925-1935).
Learning Points:
Disciform scars were the norm for untreated wet AMD prior to the anti-VEGF era that began in the mid-2000s.
New-onset wet AMD diagnosed and treated with appropriate 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.
