Question

An 80-year-old woman, with a history of type 2 diabetes mellitus, presents with slowly worsening vision. Her vision is worse in low-intensity light, and she has blurring in the center of her vision. Physical examination shows intact peripheral visual fields with a positive Amsler grid distortion. Fundoscopic exam reveals drusen located in the macula of the retina. What is the most likely diagnosis?

a) Diabetic retinopathy
b) Macular degeneration
c) Open-angle glaucoma
d) Presbyopia

Answer 1

Option B. The 80-year-old woman's symptoms and examination findings point towards age-related macular degeneration (AMD), which is the most likely diagnosis given the presence of drusen and macular involvement with symptoms of central vision loss.

Step-by-step explanation:

The most likely diagnosis for the 80-year-old woman with type 2 diabetes mellitus, who presents with slowly worsening vision that is worse in low-intensity light, blurring in the center of her vision, a positive Amsler grid distortion, and drusen located in the macula on fundoscopic exam, is macular degeneration. Macular degeneration, specifically age-related macular degeneration (AMD), is a common cause of blindness occurring because cells of the macula die. This condition leads to progressive damage to the macula, which is the part of the retina responsible for sharp, central vision.

Diabetic retinopathy, while indeed a complication of diabetes which can cause vision impairment, typically presents with different fundoscopic findings such as microaneurysms, dot hemorrhages, or neovascularization. Open-angle glaucoma is associated with peripheral vision loss, and presbyopia generally causes difficulty focusing on close objects and is related to age-related changes in the lens, not the macula.