Quick Case Challenge
A male patient aged 42 years with type 1 diabetes living in a rural area presented with blurry vision in both eyes. His primary care physician referred him to one of the nearest ophthalmologists, whose office is approximately 65 miles from the patient’s home in a different county. His wife took personal time off from work to drive him to the appointment three weeks later, where his ophthalmologist observed neovascularization of ~50% of the disc in the right eye upon dilated fundus examination. Both eyes showed a flat macula with multiple microaneurysms and hard exudates. Fluorescein angiography demonstrated evidence of abnormal vasculature and areas of capillary dropout. In the right eye there was hyperfluorescence around the neovascularization of the disc.
References
- Wang SY. The Rural Shortage of Ophthalmic Subspecialists. JAMA Ophthalmol. 2025 Jan 2. doi: 10.1001/jamaophthalmol.2024.5704. Epub ahead of print
- Lee CS, Morris A, Van Gelder RN, Lee AY. Evaluating Access to Eye Care in the Contiguous United States by Calculated Driving Time in the United States Medicare Population. Ophthalmology. 2016;123(12):2456-2461.