58-year-old with gradual onset of blurry vision

The image is consistent with a diagnosis of nonproliferative diabetic retinopathy (NPDR):

• NPDR is the early stage of diabetic retinopathy.
• Hyperglycemia damages the retinal vasculature, leading to microaneurysms that may rupture or leak and capillary occlusion causing retinal infarction.
• Diabetic retinopathy is a gradually progressive cause of vision loss that affects 1 in 3 patients with diabetes.

• Refer the patient to ophthalmology nonurgently. For diabetic retinopathy screening, refer to ophthalmology within 5 years of diagnosis of type 1 diabetes mellitus and within 1 year of diagnosis of type 2 diabetes.
• Counsel patients on the importance of glycemic control.
• Provide medical management of diabetes, hypertension, and hyperlipidemia.

• Examine the fundus with a slit-lamp biomicroscope, looking for signs of diabetic retinopathy: microaneurysms, hard exudates, dot-and-blot hemorrhages, cotton-wool spots, and macular edema.

• Assess for retinal neovascularization associated with proliferative diabetic retinopathy.
• Use optical coherence tomography to evaluate macular edema.

Treatment is based on the management of systemic conditions (ie, diabetes, hypertension, hyperlipidemia). Maintaining a hemoglobin A_1c level of less than 7% is recommended.

Anti-vascular endothelial growth factor injections can help prevent vision loss in patients with macular edema.

Ophthalmology follow-up should occur every 3-12 months depending on the severity of the diabetic retinopathy.

Diabetes and the Eye: AAO Interactive Case

The Eye and Diabetes Mellitus

Fundus Diagram

Diabetic Retinopathy

Vision Loss and Diabetic Retinopathy

Careers in Ophthalmology: Medical Retina