Quick Case Challenge

A 48-year-old male with a history of high myopia and lattice degeneration presented for a routine eye exam. The right eye showed a cotton-wool spot and blot hemorrhage along the superior arcade, while the left eye was normal. His blood pressure was 136/82, and he had not seen a primary care physician (PCP) in years. The ophthalmologist explained the findings could be related to undiagnosed hypertension or diabetes and urged follow-up with a PCP and repeat eye exam in 4 months.

The patient returned 2 years later, reporting a diagnosis of type 2 diabetes and current medications as metformin and a GLP-1 receptor agonist, which led to weight loss and glycemic control (HbA1c of 6.0). His eye examination showed worsening diabetic retinopathy (DR) in both eyes, with hemorrhages in all quadrants, hard exudates near the macula in the right eye, and increased cotton-wool spots. He was diagnosed with severe nonproliferative diabetic retinopathy (NPDR) with possible macular edema in the right eye and referred for potential anti-VEGF treatment.


















References

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