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An 89 year old man comes into your practice complaining of a drop in the quality of his vision. The patient reports that the periphery of his vision seems to be less effected than the centre of his vision. With your ophthalmoscope you observe the back of the eye to be presented with the following image. The patient has no history of diabetes and appears to have a normal blood pressure for his age. What is the likely cause of the loss in vision?


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8 (5.93%)

0 (0.00%)


Malignant hypertension

3 (2.22%)

0 (0.00%)



44 (32.59%)

0 (0.00%)


Age related macular degeneration 

64 (47.41%)

6 (100.00%)


Cataract formation.

16 (11.85%)

0 (0.00%)


The following explanation has been provided relating to this question:

Age-related macular degeneration sees the atrophy of the macular leading to the loss of rods and cones. This occurs at the centre of the retina leaving the periphery unaffected. 


Papilloedoma- This occurs when the optic disc protrudes outward due to raised inter-cranial pressure.  


Glaucoma- Inward 'cupping' of optic disc due to raised intraocular pressure. 


Malignant hypertension- Capillaries in the retina burst, optic disc bulges forward.  


Cataract- Lens becomes cloudy. 

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The following topics have been indicated as being relevant to this question:

Vessels, Neurology, clinical skills


There are 4 comments for this question (4 top-level comments and 0 replies) You may choose to agree or disagree with any of the comments previously written about this question (except comments you have written). Select either the star (agree) or the cross (disagree) to the right of the comments that you feel most strongly about. The order in which comments about this question will be displayed will be determined by the level of agreement
Written: 8:58pm, 12 DecAuthor has: 20319 points and 25 badges

Great question and explanation, a range of symptoms makes the diagnosis seem very realistic.

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Written: 9:56pm, 12 DecAuthor has: 5431 points and 13 badges

Great picture and a really helpful explanation. Thank you.

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Written: 12:58pm, 27 DecAuthor has: 15238 points and 23 badges

Excellent question

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Written: 10:23pm, 17 MayAuthor has: 6793 points and 11 badges

Great scenario/ explaination.

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