These images of diabetic retinopathy tell the story better

These images of diabetic retinopathy tell the story better medstat_tb_rest Tue, 10/13/2020 - 14:42

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These images of diabetic retinopathy tell the story better

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Kenneth Libre, MD

I read, with great interest, Dr. Farford’s thorough review article “Diabetic retinopathy: the FP’s role in preserving vision” (J Fam Pract. 2020;69:120-126). I am a family physician with ophthalmology training. For more than 20 years, I have regularly performed dilated eye exams and reviewed nonmydriatic fundus photos for uninsured patients with diabetic retinopathy (DR) at the community health clinic where I work. The burden of visual loss from poorly controlled diabetes is staggering.

I do, however, want to point out some inaccuracies in the labeling of 2 of the photos included in Table 1.

The photo labeled “Severe NPDR [nonproliferative DR]”—Figure 1A—actually shows an eye that has been treated with panretinal photocoagulation (multiple laser scars present in all quadrants) with nice regression of DR. Along the superior temporal arcade there is fibrosis, which likely represents regression of vitreal neovascularization or resolution of vitreal hemorrhage. There is little apparent active DR in this photo. The caption indicated the presence of intraretinal microvascular abnormalities; however, while these abnormalities may be present, they are not evident due to the photo resolution.

The photo labeled “Proliferative diabetic retinopathy”—Figure 2a—does not show evidence of neovascularization of the disc or the retina. This photo would be more accurately labeled “severe DR with likely clinically significant macular edema.”

The 2 photos shown here, from my photo collection, are perhaps more instructive:

FIGURE 1B is an example of severe NPDR and maculopathy (this eye has undergone previous panretinal photocoagulation, a treatment option for severe NPDR and proliferative DR [defined as new vessel growth or neovascularization]).

FIGURE 2b is an example of proliferative DR with vitreal hemorrhage that can lead to irreversible visual loss via traction retinal detachment.

I appreciate your efforts in publishing Dr. Farford’s article. DR is a broad, complicated topic, and this informative article will help many FPs.

Kenneth Libre, MD
Central City Community Health Center
Salt Lake City, UT

Article PDF

JFP06910376.PDF

Issue

The Journal of Family Practice - 69(8)

Publications

MDedge Family Medicine

The Journal of Family Practice

Type 2 Diabetes ICYMI

Topics

Diabetes

Page Number

376-377

Sections

Commentary

Author(s)

Kenneth Libre, MD

Author(s)

Kenneth Libre, MD

Article PDF

JFP06910376.PDF

Article PDF

JFP06910376.PDF

I read, with great interest, Dr. Farford’s thorough review article “Diabetic retinopathy: the FP’s role in preserving vision” (J Fam Pract. 2020;69:120-126). I am a family physician with ophthalmology training. For more than 20 years, I have regularly performed dilated eye exams and reviewed nonmydriatic fundus photos for uninsured patients with diabetic retinopathy (DR) at the community health clinic where I work. The burden of visual loss from poorly controlled diabetes is staggering.

I do, however, want to point out some inaccuracies in the labeling of 2 of the photos included in Table 1.

The photo labeled “Severe NPDR [nonproliferative DR]”—Figure 1A—actually shows an eye that has been treated with panretinal photocoagulation (multiple laser scars present in all quadrants) with nice regression of DR. Along the superior temporal arcade there is fibrosis, which likely represents regression of vitreal neovascularization or resolution of vitreal hemorrhage. There is little apparent active DR in this photo. The caption indicated the presence of intraretinal microvascular abnormalities; however, while these abnormalities may be present, they are not evident due to the photo resolution.

The photo labeled “Proliferative diabetic retinopathy”—Figure 2a—does not show evidence of neovascularization of the disc or the retina. This photo would be more accurately labeled “severe DR with likely clinically significant macular edema.”

The 2 photos shown here, from my photo collection, are perhaps more instructive:

FIGURE 1B is an example of severe NPDR and maculopathy (this eye has undergone previous panretinal photocoagulation, a treatment option for severe NPDR and proliferative DR [defined as new vessel growth or neovascularization]).

FIGURE 2b is an example of proliferative DR with vitreal hemorrhage that can lead to irreversible visual loss via traction retinal detachment.

I appreciate your efforts in publishing Dr. Farford’s article. DR is a broad, complicated topic, and this informative article will help many FPs.

Kenneth Libre, MD
Central City Community Health Center
Salt Lake City, UT

I read, with great interest, Dr. Farford’s thorough review article “Diabetic retinopathy: the FP’s role in preserving vision” (J Fam Pract. 2020;69:120-126). I am a family physician with ophthalmology training. For more than 20 years, I have regularly performed dilated eye exams and reviewed nonmydriatic fundus photos for uninsured patients with diabetic retinopathy (DR) at the community health clinic where I work. The burden of visual loss from poorly controlled diabetes is staggering.

I do, however, want to point out some inaccuracies in the labeling of 2 of the photos included in Table 1.

The photo labeled “Severe NPDR [nonproliferative DR]”—Figure 1A—actually shows an eye that has been treated with panretinal photocoagulation (multiple laser scars present in all quadrants) with nice regression of DR. Along the superior temporal arcade there is fibrosis, which likely represents regression of vitreal neovascularization or resolution of vitreal hemorrhage. There is little apparent active DR in this photo. The caption indicated the presence of intraretinal microvascular abnormalities; however, while these abnormalities may be present, they are not evident due to the photo resolution.

The photo labeled “Proliferative diabetic retinopathy”—Figure 2a—does not show evidence of neovascularization of the disc or the retina. This photo would be more accurately labeled “severe DR with likely clinically significant macular edema.”

The 2 photos shown here, from my photo collection, are perhaps more instructive:

FIGURE 1B is an example of severe NPDR and maculopathy (this eye has undergone previous panretinal photocoagulation, a treatment option for severe NPDR and proliferative DR [defined as new vessel growth or neovascularization]).

FIGURE 2b is an example of proliferative DR with vitreal hemorrhage that can lead to irreversible visual loss via traction retinal detachment.

I appreciate your efforts in publishing Dr. Farford’s article. DR is a broad, complicated topic, and this informative article will help many FPs.

Kenneth Libre, MD
Central City Community Health Center
Salt Lake City, UT

Issue

The Journal of Family Practice - 69(8)

Issue

The Journal of Family Practice - 69(8)

Page Number

376-377

Page Number

376-377

Publications

MDedge Family Medicine

The Journal of Family Practice

Type 2 Diabetes ICYMI

Publications

MDedge Family Medicine

The Journal of Family Practice

Type 2 Diabetes ICYMI

Topics

Diabetes

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Article

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These images of diabetic retinopathy tell the story better

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