Age-related Macular Degeneration: Submacular Hemorrhage
The round, brownish-black, pimple-like elevation in the macular region is a sign of bleeding under the retina. Usually it comes from new blood vessels that have burrowed into the retina from the underlying choroid.
This patient would have noticed sudden, painless vision ("metamorphopsia") in the very center of the visual field.
The most common cause is age-related macular degeneration (ARMD), an idiopathic condition responsible for most visual loss in the elderly. In this condition, the first stage is degeneration of the retinal pigment epithelium and the appearance of scattered retinal drusen, yellowish spots deep in the retina. They are associated with only mild visual acuity loss.
However, about 5% of patients with drusen move into a second stage, marked by under the retina, shown here on a fluorescein angiogram. and exudation from these vessels first distorts vision, later devastates it.
Other common causes of submacular neovascularization are angioid streaks, ocular histoplasmosis, trauma, and uveitis.
What to do?
Refer to an ophthalmologist promptly. , which leaves yellow scars, can be used in some patients with submacular neovascularization to seal the errant blood vessels and prevent them from bleeding. In addition to photocoagulation, other novel therapies have been developed.