Unit 6: Differential Diagnosis of Blurred Vision

Ophthalmology Management

Classify the retinopathy [link opens in a new window/tab]
Monitor accordingly
Fluorescein angiography

Fluorescein Angiogram

Fundus photograph of diabetic retinopathy.

Fluorescein angiogram of the same eye. The presence of leakage at the optic disc reveals a new vessel at the disc (NVD). This means that the patient has proliferative diabetic retinopathy. The angiogram also shows areas of retinal ischaemia. There is also some ischamia in the macular region. Ischaemic diabetic maculopathy is a common cause of reduced vision.

You will not be expected to interpret fluorescein angiograms, but should know why they are done.

sometimes needed to identify leaking blood vessels and macular ischaemia
Treat associated disease, eg, cataract

Laser treatment may be needed to:

Reduce macular oedema (focal macular laser )
Treat new vessel formation (pan retinal photocoagulation (PRP))

Intravitreal anti-VEGF injections:

Agents directed against vascular endothelial growth factor (VEGF), such as ranibizumab, are used as an alternative or adjunct to macular laser. They reduce vascular leakage and macular oedema. Injections usually need to be repeated

Vitrectomy surgery occasionally needed to:

Remove vitreous haemorrhage
Relieve tractional retinal detachment