Late-onset retinal macular degeneration: an entity not to be overlooked

To describe a patient with extensive geographic atrophy and night blindness.

A 59-year-old Caucasian woman of German descent presenting with progressive visual difficulty in the dark for 5 years was examined.

Her visual acuity was 20/400 in the right eye and 20/50 in the left eye. Fundus examination of both eyes showed multiple islands of geographic atrophy involving most of the posterior pole and temporal retina. There were yellow drusen-like flecks in the nasal retina. The fluorescein angiogram showed window defects and the corresponding atrophic areas showed decreased autofluorescence. A Goldmann visual field showed central scotoma and marked constriction on the right and moderate constriction on the left. An electroretinogram showed markedly decreased rod and cone function in both eyes.

Late-onset retinal macular degeneration is a rare degenerative condition that should not be mistaken for age-related macular degeneration.