OSCE Ophthalmology: NPDR This is a fundus photograph of 49 years old malay gentleman with history of diabetes mellitus for 15 years during his third eye check up at ophthalmology clinic due to blurring of vision.

Image source: http://www.kenteyesurgery.co.uk/images/Diabetes-fundus_10495760.jpg Question

1) Outline your findings in the above photograph 2) What is your provisional diagnosis? 3) What cause blurring of vision in this patient 4) How do you manage this patient

Answer

1) Findings as noted in the labelled picture 2) Non proliferative diabetic retinopathy 3) Causes of reduce vision in this diabetic retinopathy patient

a) Ischemia causing reduce blood supply to the macula b) Macula edema c) Leakage of fluid and fatty deposit under the retina d) New blood vessel formation which is bleed easily

e) blood in retina that stop light from reaching the photoreceptor cells 4) Management to this patient

a) Optimize blood sugar control b) Monitoring of blood sugar level by fasting blood sugar and Hba1c c) Focal argon laser for focal maculopathy (around microaneurysm or leaking vessels)

d) Control of hypertension if present e) Regular eye check up to see the progression of disease and necessary management.

Notes Grading of Diabetic Retinopathy

A) NPDR (Microaneurysm, small dot and blot hemorrhage, Intra retinal microvascular abnormalities) i. Mild NPDR- at least one microaneurysm and dot and blot hemorrhage in all four

quadrant ii. Moderate NPDR- plus cotton wool spot, venous bleeding iii. Severe NPDR- at least one of the following present a) severe hemorrhages and

microaneurysm an all four quadrants, b) severe venous bleeding in two quadrants and c) IRMA-more severe in one quadrant

iv. Very severe NPDR- two or more of above criteria but without presence of proliferative changes.

Reference: Samar K Basak, “Essentials of Ophthalmology 4th ed”, Current Books International, 2207