Visual loss and falls

A 75-year-old woman with age-related macular degeneration (ARMD) presents with new loss of vision in her right eye. Her past medical history is significant for hypertension, diabetes, and high cholesterol. Her medications are atenolol, insulin, simvastatin, and one aspirin per day. The patient is markedly hard of hearing and often forgets to turn on her hearing aids. She smokes one pack of cigarettes per day and has one glass of wine each evening. Her family history is significant for ARMD in her mother. The vision in the left eye was lost 2 years prior to presentation due to a subfoveal neovascular membrane from ARMD. She is the sole care provider for her elderly husband with Alzheimer's dementia, and they live together in their single family two-story home thirty miles from your office. The patient had driven herself and her husband to the appointment. Her daughter has been concerned about the increasing frailty of both parents, but the patient has refused to move previously.