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R. Ahmed, V. Khetpal, L. M. Merin, A. S. Chomsky; Retrospective Review of Retinal Arterial Emboli Found on Diabetic Retinopathy Screening by Digital Photography. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5019.
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To characterize the incidence and medical management of retinal arteriole emboli found by screening in a population of diabetic patients.
A total of 7,819 Veterans Affairs patients were screened for diabetic retinopathy from May 2003 to September 2006. Of those, 150 patients were identified with retinal arteriolar emboli. A chart review of these patients was performed to collect information on smoking status, a history of cardiovascular disorders, degree of diabetic retinopathy, and subsequent medical workup.
153 eyes in 150 patients (mean age 67) in a population of 7,819 diabetic patients were found to have retinal arteriole emboli (1.9%). 73% had previous known cardiovascular disease--22% of all patients had a previous stroke, 54% had a previous myocardial infarction, and 8.7% had valvular heart disease. 54% patients were smokers. The average visual acuity was 20/31. The average HgA1C was 6.9, and most patients had no (64%) or mild (30%) diabetic retinopathy noted at the time of screening. 71% of patients received a carotid ultrasound or echocardiogram evaluation upon alerting the primary care physician of the findings. This resulted in 21 new vascular diagnoses. Of all patients screened, 85% of patients were previously on or were initiated on antiplatelet medication following screening. 3% underwent carotid endarterectomy.
The incidence of retinal arteriole emboli among our population of diabetics (1.9%) is similar to other studies examining older populations and is greater than the documented incidence in the general population (1.0%). Interestingly, most patients in our sample had none to mild diabetic retinopathy. A majority of patients received appropriate follow-up care, although in most cases imaging did not change treatment.Further prospective studies with controls will be required to assess the relationship between diabetes and retinal emboli.
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