Differential Diagnosis for Gradual Vision Loss
The patient's symptoms of gradual vision loss, primarily in the central field of vision, with distorted lines, suggest a condition affecting the macula or optic nerve. Here's a categorized differential diagnosis:
Single most likely diagnosis
- Age-related Macular Degeneration (AMD): This is the most common cause of central vision loss in older adults. The gradual loss of central vision and distorted lines (metamorphopsia) are classic symptoms of AMD, particularly the dry form, which progresses slowly.
Other Likely diagnoses
- Diabetic Macular Edema: Given the patient's age, diabetes is a common condition that could lead to macular edema, causing central vision loss and distortion.
- Macular Hole: A small break in the macula can cause distorted and blurred vision, which might be perceived as lines appearing wavy.
- Epiretinal Membrane: This condition, also known as macular pucker, can cause vision distortion and blurriness due to a layer of fibrous tissue forming on the macula's surface.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Giant Cell Arteritis: Although less common, this condition can lead to sudden and severe vision loss if not promptly treated. It typically affects older adults and can present with symptoms of vision loss, headache, and jaw claudication.
- Optic Neuritis: An inflammation of the optic nerve, which can cause vision loss and pain. It's crucial to diagnose and treat promptly to prevent permanent vision loss.
- Pituitary Tumor: A tumor in the pituitary gland can compress the optic chiasm, leading to central vision loss. Early detection is critical for effective treatment.
Rare diagnoses
- Stargardt Disease: A rare genetic eye disorder that causes progressive vision loss, typically starting in childhood or adolescence, but can sometimes be diagnosed later in life.
- Best Vitelliform Macular Dystrophy: A rare inherited condition that affects the macula and can cause central vision loss, usually starting in childhood but sometimes diagnosed in adults.
- Choroidal Melanoma: A rare type of eye cancer that can cause vision loss if it grows large enough to affect the macula or optic nerve.