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28-year-old man was seen in the office on 2/14/2012. He has been diabetic for four months. He saw you for a comprehensive evaluation. He said you diagnosed the diabetes from retinal hemorrhages. He was hospitalized and his blood sugars were 350. His blood sugars are much better now, although he does not have a primary care doctor. You were concerned about optic nerve vessels in the right eye. VISUAL ACUITY: Vision OD is 20/25, OS is 20/20. IOP: OD 20, OS 22. SLIT LAMP EXAM: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.0. The nerve is tilted and small and there is an anomalous branching pattern of the major retinal vessels. There is a tuft of irregular telangiectatic vessels on the nasal edge of the optic nerve. There is also a buried optic nerve druse at the optic margin at 5:00 o’clock. There are rare retinal hemorrhages in the macula. OS: Vertical C/D ratio is 0.0. Again, the nerve looks small. There is an anomalous branching pattern of the retinal vessels and rare retinal hemorrhages. OCT SCAN: The OCT scan shows no retinal edema. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: The FA shows microaneurysms in both eyes, but the vessels, which are abnormal off the optic nerve in the right eye, look to be just some vascular remodeling. They do not look neovascular and they do not leak. IMPRESSION: 1. BACKGROUND DIABETIC RETINOPATHY – BOTH EYES 2. OPTIC NERVE HYPOPLASIA – BOTH EYES 3. OPTIC NERVE DRUSEN – RIGHT EYE 4. ANOMALOUS RETINAL VESSELS ON THE OPTIC NERVE – RIGHT EYE DISCUSSION: I explained to the patient I do not see anything threatening or sinister. He does have atypical nerve vessels in the right eye, but they are not neovascular. They look to be deep to the retina.

opticnervehypoplasia_jofo01.jpg
Optic Nerve Hypoplasia313 views28-year-old man with diabetes and anomalous vessels near nerve. OD is 20/25, OS is 20/20. IOP: OD 20, OS 22.
OD: Vertical C/D ratio is 0.0. The nerve is tilted and small and there is an anomalous branching pattern of the major retinal vessels. There is a tuft of irregular telangiectatic vessels on the nasal edge of the optic nerve. There is also a buried optic nerve druse at the optic margin at 5:00 o’clock. There are rare retinal hemorrhages in the macula.
OS: Vertical C/D ratio is 0.0. Again, the nerve looks small. There is an anomalous branching pattern of the retinal vessels and rare retinal hemorrhages.
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opticnervehypoplasia_jofo02.jpg
Optic Nerve Hypoplasia192 views28-year-old man with diabetes and anomalous vessels near nerve. OD is 20/25, OS is 20/20. IOP: OD 20, OS 22.
OD: Vertical C/D ratio is 0.0. The nerve is tilted and small and there is an anomalous branching pattern of the major retinal vessels. There is a tuft of irregular telangiectatic vessels on the nasal edge of the optic nerve. There is also a buried optic nerve druse at the optic margin at 5:00 o’clock. There are rare retinal hemorrhages in the macula.
OS: Vertical C/D ratio is 0.0. Again, the nerve looks small. There is an anomalous branching pattern of the retinal vessels and rare retinal hemorrhages.
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opticnervehypoplasia_jofo03.jpg
Optic Nerve Hypoplasia209 views28-year-old man with diabetes and anomalous vessels near nerve. OD is 20/25, OS is 20/20. IOP: OD 20, OS 22.
OD: Vertical C/D ratio is 0.0. The nerve is tilted and small and there is an anomalous branching pattern of the major retinal vessels. There is a tuft of irregular telangiectatic vessels on the nasal edge of the optic nerve. There is also a buried optic nerve druse at the optic margin at 5:00 o’clock. There are rare retinal hemorrhages in the macula.
OS: Vertical C/D ratio is 0.0. Again, the nerve looks small. There is an anomalous branching pattern of the retinal vessels and rare retinal hemorrhages.
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28-year-old man was seen in the office on 2/14/2012. He has been diabetic for four months. He saw you for a comprehensive evaluation. He said you diagnosed the diabetes from retinal hemorrhages. He was hospitalized and his blood sugars were 350. His blood sugars are much better now, although he does not have a primary care doctor. You were concerned about optic nerve vessels in the right eye. VISUAL ACUITY: Vision OD is 20/25, OS is 20/20. IOP: OD 20, OS 22. SLIT LAMP EXAM: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.0. The nerve is tilted and small and there is an anomalous branching pattern of the major retinal vessels. There is a tuft of irregular telangiectatic vessels on the nasal edge of the optic nerve. There is also a buried optic nerve druse at the optic margin at 5:00 o’clock. There are rare retinal hemorrhages in the macula. OS: Vertical C/D ratio is 0.0. Again, the nerve looks small. There is an anomalous branching pattern of the retinal vessels and rare retinal hemorrhages. OCT SCAN: The OCT scan shows no retinal edema. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: The FA shows microaneurysms in both eyes, but the vessels, which are abnormal off the optic nerve in the right eye, look to be just some vascular remodeling. They do not look neovascular and they do not leak. IMPRESSION: 1. BACKGROUND DIABETIC RETINOPATHY – BOTH EYES 2. OPTIC NERVE HYPOPLASIA – BOTH EYES 3. OPTIC NERVE DRUSEN – RIGHT EYE 4. ANOMALOUS RETINAL VESSELS ON THE OPTIC NERVE – RIGHT EYE DISCUSSION: I explained to the patient I do not see anything threatening or sinister. He does have atypical nerve vessels in the right eye, but they are not neovascular. They look to be deep to the retina.