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This is a 57-year-old white male farmer from West Texas with no visual symptoms who was noted to have the above lesion during a routine optometric exam.  This is the patient’s first dilated exam in his life.

1.	What is the most worrisome sign in this photo?
	a. yellow refractile pigment in fovea b. blurring/tilting of disc margin c. orangish lipofuscin overlying lesion d.  blurring of arcade vessels e. tigroid mottling of fundus
2.	If you could only perform one study on this patient, what would that be?
	a. ultrasonography b. fluorescein angiography c. OCT d.  ICG e. Goldmann visual field testing
3.	What is the most appropriate therapy?
	a. TTT (transpupillary thermotherapy) b. brachytherapy with localized I-125 plaque c. enucleation d.  observation e. photocoagulation f. cryotherapy
4.	Having astutely performed the "appropriate therapy" in question #3, what might you advise your patient?
	a. “I would go ahead and start thinking about what color glass eye you want.” b. “You can expect a near total loss of vision within 3 - 4 weeks.” c. “Bright lights will be very bothersome to you from this day forth.” d.  “You will probably retain good central vision for a couple of years, but will most likely begin to lose that thereafter.” e. “I would prepare your affairs and get ready your will.  Unfortunately, your life expectancy is probably 6 months to 1 year.”

For answers to the above, click here on or after March 20, 2007.