A 47-year-old woman with a history of hypertension and type 2 diabetes for more than 15 years was referred for proliferative diabetic retinopathy management. Her chief complaint was acute onset of blurry vision in the right eye. She described intermittent foggy vision and the appearance of “a hair moving across the vision of her right eye” for the past few weeks. Her most recent hemoglobin A1c level was 8.3%, and 2 months prior to her visit, she had restarted diabetes medications. Her medications included metformin and glimepiride. Her corrected visual acuity was 20/20 OU. Her pupil, color vision, and anterior segment examinations had normal results bilaterally. A posterior segment examination of the right eye showed mild temporal elevation of the optic disc with blurred margins, mild peripapillary hemorrhages, a small amount of preretinal hemorrhage, and small-caliber branching vessels at the temporal disc with no fibrosis (Figure 1A). The left eye showed a normal optic disc, a cup-disc ratio of 0.1, and some microaneurysms at the macula. There were a few scattered dot-blot hemorrhages bilaterally. Fluorescein angiography of the right eye showed mild leakage from the abnormal vessels at the temporal optic disc (Figure 1B).
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Benjamin J. Kim, MD, Scheie Eye Institute, University of Pennsylvania, 51 N 39th St, Philadelphia, PA 19104 (firstname.lastname@example.org).
Published Online: January 28, 2021. doi:10.1001/jamaophthalmol.2020.4670
Conflict of Interest Disclosures: Dr Kim reported having been a consultant for Allergan. No other disclosures were reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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