POHS with subretinal hemorrhage treated with Avastin

[Kathy07]

After going to my routine eye exam at my Optometrist, I discovered I could not read out of my left eye.  My prescription is -12.5. I had noticed my visions seemed blurred in that eye about a month before my appointment, but I was not alarmed and thought I needed a new prescription.  

I was sent to a retina and macula specialist and it was determined that I had a subretinal hemorrhage in my left eye.  I'm told that the there are punched out lesions in this eye and a scar spot near my macula.  I was told that the cause of the subretinal hemorhhage could be the result of my high myopia or POHS.

I am receiving Avastin injections and just had my 2nd injection today.  My vision improved from 20/200 to 20/80 in 4 weeks time.

My question is, is there a way to determine what truly caused the hemorrhage?  Are there any other treatments for the scarring and other punched out lesions.   Am I at risk for another subretinal hemorrhage in the future and how can I really know if my vision is already distorted in that eye?

I'm told I do not have any visable histo spots in my right eye.

Thank you for your help.

[Sandra M Brown, MD]

Where were you born, where did you grow up?  The Ohio river valley is the prominent area for histoplasmosis in the US, but there are other regions as well.  It would be unusual, but not impossible, to have POHS lesions in one eye only.

If it is POHS, there is no treatment for the actual POHS at this time.  Also there is no blood test to absolutely confirm the diagnosis.

With your high myopia you are independently at risk for subretinal hemorrhage, whether or not you have POHS.  So you are definitely at risk for future hemorrhages in the same or the other eye.  You have probably been advised that the vision in left eye will never return fully to normal.  So you will likely notice very early changes in the right eye because it will be your 'good' eye.  You can also monitor yourself with an Amsler grid.  Ask your doc about this.

[Kathy07]

I was born in PA near Pittsburgh.  I also attended college in West Virginia. I am 47.

My Dr. didn't say it was a sure diagnosis of histoplasmosis, but I had signs of it with the punched out lesions in my left eye.  He said whether the hemorrhage was from POHS or high myopia, the treatment of the hemorrhage would be the same.  Yes, I have been advised that the vision in my left eye will never fully return to normal and this concerns me.  

I don't know why my Optometrist never told to be aware of something like this with my high myopia.  I am very concerned that this will happen in my right eye as well.  Although my retina specialist told me that since I don't have any punched out lesions in my right eye, I'm not at a great risk for it to happen in that eye.  My doctor didn't tell me about the Amsler grid, but I have read about it.  I am going monthly for treatments though right now.

Is Avastin the common treatment for a subretinal hemorrage?