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ACP MKSAP Interdisciplinary Medicine
A 75-year-old man is evaluated for a change in vision. He reports increasing difficulty reading a computer screen, especially in his central field of vision and when the screen is not at maximum brightness. He also has a hard time seeing in the dark but does not have halos and is not sensitive to glare. He has tried several strengths of reading glasses without improvement. He has smoked one pack of cigarettes daily for 60 years. He has COPD, hypertension, and dyslipidemia. Medications include tiotropium, lisinopril, and simvastatin.
On physical examination, blood pressure is 128/78 mm Hg; other vital signs are normal. BMI is 29. Visual acuity is 20/40 bilaterally. The red reflex is present. The remainder of the examination is normal.
Which of the following is the most likely diagnosis?
A: Age-related macular degeneration
B: Cataracts
C: Optic neuritis
D: Primary open-angle glaucoma
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