Case study ( 8586 views as of May 23, 2019 )
John, a 55-year-old male who has had type 2 diabetes for 15 years, presents to his physician with blurred vision and some new floaters in the left eye, which have been occurring for 3-4 months. His hemoglobin A1C has been in the range of 9% over the past year. His blood pressures consistently are in the range of 150/90 mmHg and his serum lipids are uniformly elevated. He has not had a retinal evaluation for five years, at which time he had a dilated retinal evaluation performed by a local general ophthalmologist.
On examination, the external eye examination is normal, but there is a poor light reflex from the left eye. He is assessed by a retina specialist who sees thickening of the macula (the central retina) and new blood vessels growing on the optic nerve. The area below the nerve is hazy due to blood inside the eye. John is worried about whether or not he will be able to recover vision in the eye affected by diabetic retinopathy and what the likelihood of vision loss is in the other eye.
After receiving injections of an anti-VEGF medication in the eye, his central vision starts to recover and the blood clears. A few weeks later laser is administered to stabilize the bleeding blood vessels. After four monthly injections his vision returns to normal and remains stable.
Working with his endocrinologist and family physician, John is able to improve his systemic health status and prevent the development of similar diabetic retinopathy symptoms in his other eye. A new prescription from his optometrist improves his glasses prescription which has changed, but also stabilized, following the improved blood sugar control.Author: Dr. David Maberley