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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) 759 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) 652 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) 754 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) 570 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) 604 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) 592 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) 531 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) 628 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) 634 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) 605 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) 597 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) 646 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) 637 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) 739 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) 594 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) 706 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) 752 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) 849 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) 2143 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) 1213 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) 1115 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) 1064 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) 1665 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) 1426 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) 1697 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.