Which of the following is most likely to need immediate referral to the ophthalmologist?

A 54-year-old man, newly diagnosed with type- 2 diabetes mellitus, presents to the clinic for his first assessment. He is found to have changes in his eyes on fundoscopy.

Which of the following is most likely to need immediate referral to the ophthalmologist?
A . few dot and blot haemorrhages
B . some hard exudates > 1 disc diameter from the fovea
C . New vessels on the disc

View Answer

Answer: C

Explanation:

New vessels on the disc Background diabetic retinopathy consists of dot and blot haemorrhages and hard exudates. Patients do not need to be referred to the ophthalmologist unless these are within 1 disc diameter of the fovea. This can be monitored annually at the routine clinic. Cataracts appear about 10 years earlier in type-2 diabetes than in non-diabetic patients. If the vision is significantly affected the patients warrant routine and not urgent referral to the ophthalmologist. Soft exudates suggest retinal ischaemia, which would require routine referral to the ophthalmologist. New vessels anywhere in the fundus are a feature of proliferative retinopathy and, as new vessels have a risk of haemorrhage and can threaten sight, they should be referred urgently to the ophthalmologist.