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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.

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258 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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149 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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122 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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139 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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142 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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83 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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73 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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69 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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62 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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88 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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70 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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91 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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88 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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83 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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298 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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102 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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81 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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81 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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79 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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77 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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67 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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83 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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71 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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68 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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154 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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Diabetic Edema Better - 3 Months Follow-UP - No treatment - SD OCT137 viewsPatient remains asymptomatic and OCT shows less edema00000
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Diabetic Edema Better - 3 Months Follow-UP - No treatment - SD OCT216 viewsPatient remains asymptomatic and OCT shows less edema00000
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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.