Case Presentation

A 37-year-old male with Type 1 diabetes consulted our department for further ophthalmological treatment. The patient, diagnosed with Type 1 diabetes at 25 years old, reported poorly controlled A1C and primary hypothyroidism. Upon presentation, his visual acuity was 20/40 and 20/25 in the right eye and left eye, respectively. He had a history of bilateral diabetic retinopathy and macular edema, for which he was treated with an intravitreal injection (IVT) in both eyes
2 months ago in Spain. For patients with Type 1 diabetes and a history of poorly controlled A1C, it was important that we capture multimodal imaging given the risk of quick progression in this case. 

Imaging Findings

Optos ultra-widefield (UWF) color red-green-blue (RGB) and UWF fluorescein angiography imaging supported the diagnosis of proliferative diabetic retinopathy in both eyes. Imaging revealed microaneurysms, dot-blot hemorrhages, cotton wool spots, hard exudates, venous abnormalities/venous beading, capillary occlusions and leakage, retinal ischemia and retinal neovascularization—findings consistent with proliferative diabetic retinopathy. All retinal lesions noted were visualized in a single Optos UWF RGB capture with a 200-degree expansive view that when zoomed allowed for better assessment of the lesions due to the high resolution of the macular region. The high quality and sharpness of just one Optos UWF RGB image taken in less than 0.5 seconds allowed for diagnosis. 

Based on the findings and diagnosis, the patient is scheduled for monthly anti-VEGF IVTs and panretinal photocoagulation (PRP) in both eyes.

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Ali Erginay, MD, is a senior consultant ophthalmologist specializing in vitreo-retinal disorders at Lariboisière Hospital in Paris, France. He graduated from the Paris 6 medical faculty and also holds a degree in Computer Science. His research focuses on diabetic retinopathy, and he participates in various national and international clinical trials dealing with vascular diseases of the retina. He is also interested in computerized medical imaging techniques.

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