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Diabetic Retinopathy (Non-Proliferative, Very Mild)
ILLUSTRATION: At first glance, this retina appears normal. However, on careful observation, the subtle changes of early retinopathy can be seen. Temporal to the macula at 4 o'clock is a small yellow deposit, a hard exudates (arrow). This is a deposit of lipoprotein that has leaked from the incompetent capillary network. Adjacent to it, is a small collection of tiny red dots. These are most likely microaneurysms but could be small hemorrhages. Clinically they look the same but could be distinguished by fluorescein angiography. There is a small red dot in the fovea and several more scattered around the posterior pole. These findings are indeed subtle but present.
There is no clinically significant macular edema and no threat to vision at this stage. However, this patient should be referred for a baseline eye exam.
DISCUSSION: Minimal or very mild diabetic retinopathy without threat to vision may be followed at the recommended yearly intervals. Some patients may require a follow up in six months if the previous examination was negative for the diabetic retinopathy. The duration of time from the diagnosis of diabetes mellitus to the onset of clinical diabetic retinopathy is highly variable. In many cases the onset of diabetes mellitus is not clear and thus the recommended retinal examination is at baseline and then yearly or sooner if retinopathy is advancing.
It is important for the patient to be educated that tight control of his/her serum glucose, reflected by the HbA1C, is important in preventing or reducing the severity of the ophthalmic complications of diabetes. This is also true with regard to the renal and neurological complications.