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JAMA Ophthalmology Clinical Challenge
July 18, 2019

A Patient With Type 1 Diabetes, Visual Acuity Loss, and Retinal Thickening

Author Affiliations
  • 1Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
  • 2Service d’Ophtalmologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
  • 3Bordeaux Population Health Research Center, Team Lifelong Exposures Health and Aging, Unité 1219, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France
  • 4Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
JAMA Ophthalmol. 2019;137(9):1078-1079. doi:10.1001/jamaophthalmol.2019.2137

A 24-year-old man presented with substantial loss of visual acuity in the left eye. He had been diagnosed with type 1 diabetes 5 years prior and had never been examined for diabetic retinopathy. At the initial examination, his hemoglobin A1c level was 11.0% (to convert to the proportion of total hemoglobin, multiply by 0.01), suggesting a lack of compliance with his diabetic treatment regimen. His best-corrected visual acuity (BCVA) was 20/100 OS and 20/60 OD. On examination of the left eye, the anterior segments were unremarkable, with no neovascularization of the angle or iris. However, there was considerable retinal thickening, substantial capillary nonperfusion in the macular area, and a large area of disc neovascularization (in more than one-third of the disc area), with leakage on the disc associated with prepapillary neovascularization, as confirmed by fluorescein angiography (Figure 1A). Optical coherence tomography confirmed retinal thickening in the macular area (central subfield thickness [CST], 805 μm), with cystoid abnormalities throughout the retinal layers as well as subretinal fluid (Figure 1B).

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