This 64YO diabetic female presented with asymptomatic severe nonproliferative diabetic retinopathy (NPDR) in her left eye. Vision was 20/40.
Optos color imaging shows venous beading inferonasally. Fluorescein angiography shows severe retinal ischemia with venous staining.
Our patient’s ischemia was localized just to one quadrant with good perfusion elsewhere, so we are following her closely.
Learning Points:
Severe NPDR is defined as severe (at least 20) retinal hemorrhages in all quadrants, beading in at least 2 quadrants, or intraretinal microvascular abnormalities in 1 quadrant. These eyes are at significant risk for progressing to proliferative disease, so we will often treat with panretinal photocoagulation before neovascularization develops.
In our experience, eyes with significant venous beading or venous loops more often than not already have proliferative disease.
