A 47-year-old man presented with gradual onset of blurry vision in both eyes for several months. Best-corrected visual acuity was 20/20 OD and 20/40 OS. Intraocular pressure was 23 mm Hg in both eyes and was more than 21 mm Hg in both eyes on multiple visits. Medical history included hypertension, obesity, left adrenalectomy, and pterygium excision surgery in the left eye. The patient denied previous episodes of blurry vision, history of corticosteroid use, sleep apnea, or type-A personality. Complete review of systems was otherwise negative. Amsler grid testing revealed paracentral metamorphopsia in both eyes. Extraocular motility, pupillary light reactions, and confrontational visual fields were normal. Slitlamp examination and gonioscopy results were normal in both eyes. An external photograph of the patient is shown in Figure 1A. Fluorescein angiography demonstrated multiple areas of late pinpoint leakage and patches of mottled hyperfluorescence in both eyes (Figure 1B).
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Fowler BJ, Nguyen JL, Sridhar J. Metamorphopsia in a Middle-aged Man. JAMA Ophthalmol. Published online July 15, 2021. doi:10.1001/jamaophthalmol.2020.7095
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