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Diabetic Macular Edema - SD-OCT - Clinically Significant Macular Edema with Normal Central Vision 63-year-old man was seen in the office on May 10, 2012. He has been diabetic for twenty two years. He did have a stroke in September. He lost his right peripheral vision. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25. IOP: OD 11, OS 14. SLIT EXAMINATION: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.6. There is no posterior vitreous separation. There is exudate and microaneurysms clustered particularly inferior to the fovea. OS: Vertical C/D ratio is 0.6. There is no posterior vitreous separation. There is exudate and microaneurysms clustered superior to the fovea. In both eyes there does appear to be edema within 500 microns of the center of the fovea. SPECTRALIS-SD-OCT SCAN: The OCT scan in the right eye shows an average central foveal thickness of 270 microns, which is normal. The left eye shows an average central foveal thickness of 258 microns, which is normal. Both eyes though do have edema within less than a disc-diameter in the center. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows microaneurysms leaking inferior to the fovea in the right eye and superior to the fovea in the left eye. FUNDUS PHOTOGRAPHY - INFRA RED: The infra red and auto fluorescence images show a cluster of microaneurysms inferior to the fovea with some hemorrhage in that area. The infra red and auto fluorescence images in the left eye show microaneurysms clustered superior to the fovea with some hemorrhage in that area. IMPRESSION: 1. BACKGROUND DIABETIC RETINOPATHY – BOTH EYES 2. CLINICALLY SIGNIFICANT MACULAR EDEMA – BOTH EYES DISCUSSION: I explained to the patient he does have diabetic macular edema in both eyes. The ETDRS study shows that laser treatment is beneficial in this situation, however, the sub group analysis show that people with good vision there didn’t seem to be any difference between treated and non treated patients in two years. Therefore I think it is reasonable with today’s technology, to follow him closely and treat him should the edema worsen and not treat him should the edema stabilize or improve. To that I asked him to return for a check in three to four months or sooner should he notice a problem.
947 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	736 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	678 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	706 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)
708 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	583 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	506 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	540 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)
551 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	582 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	579 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	593 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)
590 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	568 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	798 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	633 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)
567 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	616 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	575 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	552 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)
600 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	524 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	524 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	536 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)
714 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25 (0 votes)	Diabetic Edema Better - 3 Months Follow-UP - No treatment - SD OCT685 viewsPatient remains asymptomatic and OCT shows less edema (0 votes)	Diabetic Edema Better - 3 Months Follow-UP - No treatment - SD OCT812 viewsPatient remains asymptomatic and OCT shows less edema (0 votes)
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63-year-old man was seen in the office on May 10, 2012. He has been diabetic for twenty two years. He did have a stroke in September. He lost his right peripheral vision. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25. IOP: OD 11, OS 14. SLIT EXAMINATION: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.6. There is no posterior vitreous separation. There is exudate and microaneurysms clustered particularly inferior to the fovea. OS: Vertical C/D ratio is 0.6. There is no posterior vitreous separation. There is exudate and microaneurysms clustered superior to the fovea. In both eyes there does appear to be edema within 500 microns of the center of the fovea. SPECTRALIS-SD-OCT SCAN: The OCT scan in the right eye shows an average central foveal thickness of 270 microns, which is normal. The left eye shows an average central foveal thickness of 258 microns, which is normal. Both eyes though do have edema within less than a disc-diameter in the center. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows microaneurysms leaking inferior to the fovea in the right eye and superior to the fovea in the left eye. FUNDUS PHOTOGRAPHY - INFRA RED: The infra red and auto fluorescence images show a cluster of microaneurysms inferior to the fovea with some hemorrhage in that area. The infra red and auto fluorescence images in the left eye show microaneurysms clustered superior to the fovea with some hemorrhage in that area. IMPRESSION: 1. BACKGROUND DIABETIC RETINOPATHY – BOTH EYES 2. CLINICALLY SIGNIFICANT MACULAR EDEMA – BOTH EYES DISCUSSION: I explained to the patient he does have diabetic macular edema in both eyes. The ETDRS study shows that laser treatment is beneficial in this situation, however, the sub group analysis show that people with good vision there didn’t seem to be any difference between treated and non treated patients in two years. Therefore I think it is reasonable with today’s technology, to follow him closely and treat him should the edema worsen and not treat him should the edema stabilize or improve. To that I asked him to return for a check in three to four months or sooner should he notice a problem.