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September 20, 2010. This pleasant 73-year-old man has diabetes for some time. He has been seeing me. His vision is fine since he was here last, which was July 20th. He is however, lately feeling sick. He had a twelve pound weight loss in the last four months. He doesn’t feel good and his blood pressure was low. He stopped one of his blood pressure medications and he is still not feeling very well. He has had a lot of blood testing done and he had bone marrow aspiration. He is currently under evaluation for possible systemic problems. VISUAL ACUITY: OD 20/30, OS 20/25. IOP: 14 OU. There is 3+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. There is partial posterior vitreous separation with cotton wool spots clustered around the optic nerve. There are rare retinal hemorrhages. OS: Vertical C/D ratio is 0.3. There is posterior vitreous separation and cotton wool spots clustered around the optic nerve. His blood pressure was normal about 105/60. Photos confirm clinical findings. IMPRESSION: 1. COTTON WOOL SPOTS – BOTH EYES DISCUSSION: I explained to the patient he does have cotton wool spots in both eyes suggestive of possible systemic problems. The most common diagnosis at this moment for cotton wool spots is HIV retinopathy, however, they all can all be seen in patients with systemic lupus erythematosus and diabetes, although in his case I don’t believe this is associated with his diabetic retinopathy. Other problems need to be checked for a possible collagen vascular disease and leukemia and hypertension. I asked him to see you back regularly. I told him he should return here in two months. Thank you for allowing me to participate in his care. Patient was diagnosed within a week with Chronic Lymphocytice Leukemia

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Cotton Wool Spots and New Diagnosis of Chronic Lymphocytic leukemia169 views73-year-old man with cotton wool spots diagnosed subsequently with with Chronic Lymphocytice Leukemia00000
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Cotton Wool Spots and New Diagnosis of Chronic Lymphocytic leukemia260 views73-year-old man with cotton wool spots diagnosed subsequently with with Chronic Lymphocytice Leukemia00000
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Cotton Wool Spots and New Diagnosis of Chronic Lymphocytic leukemia166 views73-year-old man with cotton wool spots diagnosed subsequently with with Chronic Lymphocytice Leukemia00000
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Cotton Wool Spots and New Diagnosis of Chronic Lymphocytic leukemia250 views73-year-old man with cotton wool spots diagnosed subsequently with with Chronic Lymphocytice Leukemia00000
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Cotton Wool Spots and New Diagnosis of Chronic Lymphocytic leukemia181 views73-year-old man with cotton wool spots diagnosed subsequently with with Chronic Lymphocytice Leukemia00000
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Cotton Wool Spots and New Diagnosis of Chronic Lymphocytic leukemia229 views73-year-old man with cotton wool spots diagnosed subsequently with with Chronic Lymphocytice Leukemia00000
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September 20, 2010. This pleasant 73-year-old man has diabetes for some time. He has been seeing me. His vision is fine since he was here last, which was July 20th. He is however, lately feeling sick. He had a twelve pound weight loss in the last four months. He doesn’t feel good and his blood pressure was low. He stopped one of his blood pressure medications and he is still not feeling very well. He has had a lot of blood testing done and he had bone marrow aspiration. He is currently under evaluation for possible systemic problems. VISUAL ACUITY: OD 20/30, OS 20/25. IOP: 14 OU. There is 3+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. There is partial posterior vitreous separation with cotton wool spots clustered around the optic nerve. There are rare retinal hemorrhages. OS: Vertical C/D ratio is 0.3. There is posterior vitreous separation and cotton wool spots clustered around the optic nerve. His blood pressure was normal about 105/60. Photos confirm clinical findings. IMPRESSION: 1. COTTON WOOL SPOTS – BOTH EYES DISCUSSION: I explained to the patient he does have cotton wool spots in both eyes suggestive of possible systemic problems. The most common diagnosis at this moment for cotton wool spots is HIV retinopathy, however, they all can all be seen in patients with systemic lupus erythematosus and diabetes, although in his case I don’t believe this is associated with his diabetic retinopathy. Other problems need to be checked for a possible collagen vascular disease and leukemia and hypertension. I asked him to see you back regularly. I told him he should return here in two months. Thank you for allowing me to participate in his care. Patient was diagnosed within a week with Chronic Lymphocytice Leukemia