A 65-year-old man presents with complaints of decreased vision in both eyes. His visual impairment has been progressively worsening over the past five months. He was diagnosed with diabetes ten years ago. His current medications are metformin and glyburide. His blood pressure is 140/90 mm Hg, pulse is 82/min, respirations are 14/min, and temperature is 98.4° F (36.8° C). Examination shows decreased visual acuity in both eyes. Ophthalmoscopy reveals microaneurysms, dot and blot hemorrhages, hard exudates, and macular edema. Which of the following is the most likely diagnosis?

Question

A 65-year-old man presents with complaints of decreased vision in both eyes.  His visual impairment has been progressively worsening over the past five months.  He was diagnosed with diabetes ten years ago.  His current medications are metformin and glyburide.  His blood pressure is 140/90 mm Hg, pulse is 82/min, respirations are 14/min, and temperature is 98.4° F (36.8° C).  Examination shows decreased visual acuity in both eyes.  Ophthalmoscopy reveals microaneurysms, dot and blot hemorrhages, hard exudates, and macular edema.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Diabetic retinopathy is the leading cause of blindness in the USA. It occurs in both insulin dependent and non-insulin dependent diabetes mellitus. There are 3 main categories: background or simple retinopathy - consists of microaneurysms, hemorrhages, exudates, and retinal edema, as in this patientpre-proliferative retinopathy - with cotton wool spotsproliferative or malignant retinopathy - consists of newly formed vessels. background or simple retinopathy - consists of microaneurysms, hemorrhages, exudates, and retinal edema, as in this patient pre-proliferative retinopathy - with cotton wool spots proliferative or malignant retinopathy - consists of newly formed vessels. Patients are usually asymptomatic at first, despite early signs of retinopathy (e.g., microaneurysms). Visual impairment occurs with the development of macular edema. Argon laser photocoagulation is the suggested treatment for the prevention of complications. (Choice A) Central retinal vein occlusion is characterized by sudden, unilateral visual impairment that is usually noted upon waking in the morning. Diabetics are at increased risk for retinal vein occlusion. Ophthalmoscopy reveals disc swelling, venous dilation and tortuosity, retinal hemorrhages and cotton wool spots. (Choice C) Macular degeneration affects central vision. It is characterized by distorted vision and central scotoma. Cigarette smoking increases the risk of macular degeneration. Ophthalmoscopy findings vary according to the type (i.e., atrophic vs. exudative). The atrophic form is characterized by multiple sores in the macular region, while the exudative form is characterized by new blood vessels that may leak, bleed, and scar the retina. (Choice D) Retinal detachment occurs unilaterally. It presents as blurred vision that progressively worsens. Ophthalmoscopy reveals the retina hanging in the vitreous. (Choice E) Open angle glaucoma is also seen in diabetics, but is characterized by gradual loss of peripheral vision, resulting in tunnel vision. Ophthalmoscopy shows pathologic cupping of the optic disc. Educational Objective: The 3 main categories of diabetic retinopathy are background or simple (microaneurysms, hemorrhages, exudates, retinal edema), pre-proliferative (cotton wool spots), and proliferative or malignant (neovascularization). Visual impairment occurs with the development of macular edema. Argon laser photocoagulation is performed for the prevention of complications.

A 65-Year-Old Man Presents with Complaints of Decreased Vision in Both