This patient, a 49-year-old Malay man, was experiencing blurred vision and was found to have non-proliferative diabetic retinopathy (NPDR) during his third eye exam over 15 years after being diagnosed with diabetes. NPDR was diagnosed based on findings of microaneurysms, dot and blot hemorrhages, and intraretinal microvascular abnormalities. The blurred vision was likely caused by ischemia reducing blood supply to the macula, macular edema, leakage of fluid and fatty deposits under the retina, or bleeding from new fragile blood vessels. Management includes optimizing blood sugar control, regular monitoring, focal laser treatment for macular edema, controlling hypertension, and follow-up eye exams.

1. OSCE Ophthalmology: NPDR
This is a fundus photograph of 49 years old malay gentleman with history of diabetes mellitus
for 15 years during his third eye check up at ophthalmology clinic due to blurring of vision.
Image source: http://www.kenteyesurgery.co.uk/images/Diabetes-fundus_10495760.jpg
Question
1) Outline your findings in the above photograph
2) What is your provisional diagnosis?
3) What cause blurring of vision in this patient
4) How do you manage this patient
Answer
1) Findings as noted in the labelled picture
2) Non proliferative diabetic retinopathy
3) Causes of reduce vision in this diabetic retinopathy patient
a) Ischemia causing reduce blood supply to the macula
b) Macula edema
c) Leakage of fluid and fatty deposit under the retina
d) New blood vessel formation which is bleed easily

2. e) blood in retina that stop light from reaching the photoreceptor cells
4) Management to this patient
a) Optimize blood sugar control
b) Monitoring of blood sugar level by fasting blood sugar and Hba1c
c) Focal argon laser for focal maculopathy (around microaneurysm or leaking vessels)
d) Control of hypertension if present
e) Regular eye check up to see the progression of disease and necessary management.
Notes
Grading of Diabetic Retinopathy
A) NPDR (Microaneurysm, small dot and blot hemorrhage, Intra retinal microvascular
abnormalities)
i. Mild NPDR- at least one microaneurysm and dot and blot hemorrhage in all four
quadrant
ii. Moderate NPDR- plus cotton wool spot, venous bleeding
iii. Severe NPDR- at least one of the following present a) severe hemorrhages and
microaneurysm an all four quadrants, b) severe venous bleeding in two quadrants
and c) IRMA-more severe in one quadrant
iv. Very severe NPDR- two or more of above criteria but without presence of
proliferative changes.
Reference: Samar K Basak, “Essentials of Ophthalmology 4th ed”, Current Books
International, 2207