Diabetic papillopathy diagnosed on retinal screening in an asymptomatic patient

Abstract

Case study A 50-year-old Asian lady was diagnosed with type 2 diabetes mellitus in 1995. Compliance with diet and medications was poor. On maximal oral hypoglycaemic therapy (metformin, glibenclamide and rosiglitazone), the HbA1C was 9.1%. She refused insulin treatment on many occasions. She also had hypertension, microalbuminuria and hypercholesterolaemia. Retinal photographs (figure 1) taken in 2004 (visual acuity of right eye 6/6, left eye 6/6) showed background diabetic retinopathy. Repeat retinal pictures in 2006 are shown in figure 2 and left optic disc swelling noted. She denied any headache and visual acuity was 6/9 in both eyes. In view of the left disc oedema, she was referred to the ophthalmology department. Her visual acuity was 6/6 in each eye and her colour vision was normal. There was no uveitis or relative afferent pupillary defect. Formal visual fields were done (figure 3) which showed an enlarged left blind spot and some central visual field loss below the horizontal meridian in the left eye. The right visual field was normal. Her blood pressure was well controlled (130/80 mmHg) on medication. Blood tests which included full blood count, ESR, autoantibody screen, serum ACE, syphilis screen, B12 and Folate were all normal. Fluorescein angiography (figure 4) revealed dilated vessels over the optic disc with generalised leakage of dye at the optic disc, consistent with diabetic papillopathy.