A 72-Year-Old Man Comes to the Office for a Regular

A 72-year-old man comes to the office for a regular visit.  His vision has been deteriorating gradually for the past year.  The patient has been having difficulty reading the newspaper and has been using reading glasses more frequently to read small print.  Lately, he has also had difficulty driving and now drives only during the daytime.  The patient has a history of hypertension and osteoarthritis.  He has smoked a pack of cigarettes daily for 38 years.
His blood pressure is 155/77 mm Hg and pulse is 76/min.  BMI is 31 kg/m².  Ocular examination shows no visible abnormalities of the cornea or lens, and the pupils are round and reactive.  Visual acuity is diminished in both eyes, the left eye more than the right.  Funduscopic examination shows mottling of sub-retinal pigments and bright yellow drusen deposits in the macular area of the left retina.  Cardiopulmonary and neurologic examination is unremarkable.
Which of the following is the best initial management of this patient's vision problems?

A) Aggressive hypertension control
B) Daily low-dose aspirin
C) Immediate smoking cessation
D) Laser photocoagulation
E) Weight loss

Correct Answer:

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