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Last additions - Diabetic Macular Edema - Hypertensive Retinopathy - Circinate Exudate 55-year-old woman was seen in the office on 9/25/2009. She has been diabetic for fifteen years. She has always had some trouble getting her diabetes lined up. She also has Crohn’s disease and fibromyalgia. She has had a problem with high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60. IOP: OD 18, OS 17. SLIT LAMP EXAM: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. On the inferotemporal portion of the optic nerve there are lacy fine vessels which look to be neovascular. There are patchy retinal hemorrhages. There are microaneurysms around the fovea. There are exudates and there is macular edema, including cystoid macular edema. OS: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. There are multiple cotton-wool spots, retinal hemorrhages, exudates, as well as edema. OCT SCAN: There is foveal edema in both eyes. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows multiple staining microaneurysms in both eyes with areas of nonperfusion. There is neovascularization on the inferotemporal margin of the optic nerve of the left eye. IMPRESSION: 1. BACKGROUND DIABETIC RETINOPATHY – RIGHT EYE 2. PROLIFERATIVE DIABETIC RETINOPATHY – LEFT EYE 3. DIABETIC MACULAR EDEMA – BOTH EYES 4. HYPERTENSIVE RETINOPATHY – BOTH EYES 5. CATARACTS 6. SEROUS MACULAR DETACHMENT – RIGHT EYE DISCUSSION: I explained to the patient that she does have worsening vision from a combination of diabetic retinopathy and hypertensive retinopathy. I believe with time her vision may improve but because of the severity of the macular swelling and retinal vascular damage, I suggest we do laser treatment to the right eye today, which has an excellent chance of reducing the risk of further vision loss and will probably help improve the vision. I treated the right eye with focal laser without any difficulty. The patient will return for evaluation and probable treatment in the fellow eye this coming Tuesday. Subsequent to that, if her vision does not start to improve within a few weeks, I will probably inject each eye with steroids.
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 721 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 609 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 707 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 520 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 582 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 549 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 505 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 572 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 595 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 555 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 564 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 581 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 596 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 688 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 544 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 683 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 717 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 814 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 2086 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 1153 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 1059 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 1025 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 1601 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011	Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 1366 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011
Diabetic Macular Edema and Hypertensive Retinopathy - Circinate Exudate (Ring Exudate) 1632 views55-year-old woman diabetic for fifteen years and high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60Jun 16, 2011
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55-year-old woman was seen in the office on 9/25/2009. She has been diabetic for fifteen years. She has always had some trouble getting her diabetes lined up. She also has Crohn’s disease and fibromyalgia. She has had a problem with high blood pressure, especially over the last few months. She has had problems with nosebleeds, headaches, and there has been some difficulty bringing her blood pressure down. She said now the blood pressure is under control but it was running 220/120 mmHg for some time. Her vision in the right eye has been poor for four weeks with a spot in the central vision and both eyes have been blurred. VISUAL ACUITY: Vision OD is 20/160, OS is 20/60. IOP: OD 18, OS 17. SLIT LAMP EXAM: There is 2+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. On the inferotemporal portion of the optic nerve there are lacy fine vessels which look to be neovascular. There are patchy retinal hemorrhages. There are microaneurysms around the fovea. There are exudates and there is macular edema, including cystoid macular edema. OS: Vertical C/D ratio is 0.1. There is no posterior vitreous separation. There are multiple cotton-wool spots, retinal hemorrhages, exudates, as well as edema. OCT SCAN: There is foveal edema in both eyes. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows multiple staining microaneurysms in both eyes with areas of nonperfusion. There is neovascularization on the inferotemporal margin of the optic nerve of the left eye. IMPRESSION: 1. BACKGROUND DIABETIC RETINOPATHY – RIGHT EYE 2. PROLIFERATIVE DIABETIC RETINOPATHY – LEFT EYE 3. DIABETIC MACULAR EDEMA – BOTH EYES 4. HYPERTENSIVE RETINOPATHY – BOTH EYES 5. CATARACTS 6. SEROUS MACULAR DETACHMENT – RIGHT EYE DISCUSSION: I explained to the patient that she does have worsening vision from a combination of diabetic retinopathy and hypertensive retinopathy. I believe with time her vision may improve but because of the severity of the macular swelling and retinal vascular damage, I suggest we do laser treatment to the right eye today, which has an excellent chance of reducing the risk of further vision loss and will probably help improve the vision. I treated the right eye with focal laser without any difficulty. The patient will return for evaluation and probable treatment in the fellow eye this coming Tuesday. Subsequent to that, if her vision does not start to improve within a few weeks, I will probably inject each eye with steroids.