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Michelle Jangmi Kim, Donald S Fong; Retinal Emboli Detected on Fundus Photography in Patients who Undergo Diabetic Retinopathy Screening. Invest. Ophthalmol. Vis. Sci. 2014;55(13):271.
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The presence of retinal emboli has been associated with increased mortality. The purpose of this study was to determine the clinical characteristics of diverse southern California Kaiser Permanente patients who are found to have retinal emboli on diabetic retinopathy screening, identify the type of workup performed in these patients, and assess the stroke, cardiovascular, and all-cause mortality rates in these patients.
Retrospective chart review was performed on 121 consecutive patients found to have retinal emboli on fundus photography during diabetic retinopathy screening across 12 centers in the southern California Kaiser Permanente network between July 21, 2011 and April 16, 2013.
The mean age was 67 years (median 68, range 36-87) with 70% males. Seventy-two patients (60%) with retinal emboli were referred to ophthalmology, and 90% all of these patients had a best corrected visual acuity of 20/60 or better (10% unknown). Only 26% of patients referred for retinal emboli were found to have an embolus on ophthalmoscopy. Of the 19 patients with a definite embolus on exam, 2 were found to have significant carotid artery stenosis and 7 had cardiac valvular disease. During a mean follow-up of 1.1 years (median 1.0, range 0.49-2.25), 2 patients suffered a myocardial infarction, 3 had a stroke, and 5 died (2 cardiovascular disease, 2 respiratory failure, 1 unknown).
Compared to patients in other studies, Kaiser Permanente patients with retinal emboli were of more diverse ethnic backgrounds and had a greater proportion of males. The low number of retinal emboli detected on subsequent ophthalmological exam could reflect the transient nature of emboli, low sensitivity of ophthalmoscopy, or unclear indication for referral in some cases. Despite the relatively short length of follow-up, our study suggests that the presence of retinal emboli in diabetics confers an increased mortality risk.
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