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Most viewed - 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.
941 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	Diabetic Edema Better - 3 Months Follow-UP - No treatment - SD OCT804 viewsPatient remains asymptomatic and OCT shows less edema	793 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	727 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25
708 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	699 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	697 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	Diabetic Edema Better - 3 Months Follow-UP - No treatment - SD OCT680 viewsPatient remains asymptomatic and OCT shows less edema
674 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	629 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	605 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	594 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25
589 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	583 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	579 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	574 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25
573 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	570 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	564 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	564 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25
548 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	547 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	535 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	529 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25
520 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	519 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25	494 views63-year-old man diabetic for twenty two years. His central vision is fine. VISUAL ACUITY: OD 20/25, OS 20/25
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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.