Differentials
Idiopathic polypoidal choroidal vasculopathy
SIGNS / SYMPTOMS
Signs and symptoms may be similar to exudative AMD, particularly occult forms.
Hemorrhagic pigment epithelial detachment is particularly suggestive of this condition.
INVESTIGATIONS
Indocyanine green angiography demonstrates characteristic choroidal polyps.
Basal laminar drusen
SIGNS / SYMPTOMS
Multiple, discrete, often calcified drusen.
Symmetric in both eyes.
May be associated with choroidal neovascularization or pseudovitelliform macular lesions.
Demographic may be different: may be seen in younger patients and nonwhite ethnicities.
INVESTIGATIONS
No differentiating tests: differentiated on the basis of history and clinical exam.
Myopic degeneration
SIGNS / SYMPTOMS
Present in patients with high myopia.
Associated with typical features of high myopia: tilted nerve head and posterior staphyloma.
May be associated with macular pigmentary changes and choroidal neovascularization.
Drusen not present.
Demographic may be different: may be seen in younger patients and nonwhite ethnicities.
INVESTIGATIONS
No differentiating tests: differentiated on the basis of history and clinical exam.
Refraction may reveal high myopia: may not be seen if a patient has undergone refractive surgery, such as laser-assisted in situ keratomileusis, or cataract surgery with intraocular lens implantation.
Ocular histoplasmosis syndrome
SIGNS / SYMPTOMS
High incidence in people residing in the Mississippi River Valley and nearby areas.
Peripapillary atrophy and punched-out chorioretinal scars in the macula and periphery observed.
Drusen not present.
May be associated with choroidal neovascularization.
Demographic may be different: may be seen in younger patients and nonwhite ethnicities.
INVESTIGATIONS
No differentiating tests: differentiated on the basis of history and clinical exam.
Angioid streaks
SIGNS / SYMPTOMS
May be associated with choroidal neovascularization.
Characterized by the presence of angioid streaks on fundoscopic exam.
Drusen not present.
Demographic may be different: may be seen in younger patients and nonwhite ethnicities.
May be associated with Ehlers-Danlos syndrome, Paget disease, pseudoxanthoma elasticum, and sickle cell disease.
INVESTIGATIONS
No differentiating tests: differentiated on the basis of history and clinical exam.
Fluorescein angiography may be useful to confirm the presence of angioid streaks.
Traumatic choroidal neovascularization
SIGNS / SYMPTOMS
May be associated with rupture of Bruch's membrane with subsequent choroidal neovascularization.
Drusen not present.
Usually unilateral.
Demographic may be different: may be seen in younger patients and nonwhite ethnicities.
Other findings of ocular trauma may be present.
INVESTIGATIONS
No differentiating tests: differentiated on the basis of history and clinical exam.
Idiopathic choroidal neovascularization
SIGNS / SYMPTOMS
Drusen not present.
Usually unilateral.
Demographic may be different: may be seen in younger patients and nonwhite ethnicities.
INVESTIGATIONS
No differentiating tests: differentiated on the basis of history and clinical exam.
Adult vitelliform macular degeneration
SIGNS / SYMPTOMS
Lipofuscin/vitelliform deposition in between neurosensory retina and retinal pigment epithelium. Macular pigmentary changes.
INVESTIGATIONS
Lipofuscin deposition may cause increased autofluorescence. Fluorescein angiography, optical coherence tomography, and/or indocyanine green angiography can often help distinguish entities that may mimic AMD.
Macular vein occlusions
SIGNS / SYMPTOMS
Retinal hemorrhages and exudates.
INVESTIGATIONS
Fluorescein angiography, optical coherence tomography, and/or indocyanine green angiography can often help distinguish entities that may mimic AMD.
Idiopathic perifoveal telangiectasia
SIGNS / SYMPTOMS
Small aneurysms, hemorrhages, exudates.
INVESTIGATIONS
Fluorescein angiography, optical coherence tomography, and/or indocyanine green angiography can often help distinguish entities that may mimic AMD.
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