drusens,.etc

[jbo6679]

I have type II diabetes, well controlled.   I had the retinal screening exam in July, and the report was..."no problems noted".  But in the fall, I saw an optometrist to update my glasses.   She noted an early cataract in one eye, and some "drusens" in the other.    My primary care physician does not see any reason to refer me to an opthamologist, since the retinal report was good.    Note that I have NEVER actually had an opthamologist look in my eye.....at the -Navy hospital, a technician takes a high resolution digital image of the retina.   Sometime later, the retinal specialist reviews that and mails out the report.  Since my A1c is below 7, they will only repeat this exam every 2 years.

Should I be concerned at all, and should I just go out on my own and get an eye examination??

Thanks for any suggestions.

[John C Hagan III, MD, FACS, FAAO]

In my opinion you need to see an Eye MD ophthalmologist. The training of an optometrist is very restricted and they are not physicians. There are numerous types of drusen on the back of the eye: optic nerve drusen, hard drusen, soft drusen, mid-peripheral drusen. Each has different visual implications and some are dangerous.

I would be insistent on gettin a Eye MD referal from your GP.

JCH III MD

[Michael J Kutryb, MD]

Good question - here in this situation, I'm not sure who to believe.  The main thing is that no diabetic retinopathy was noted.  I think the best thing to do is to ask the optometrist to give you a written report or copy of any photos done.  Ask the optometrist if a dilated exam was done.  If not done - then wouldn't put much faith in the retinal findings.  Ask the optometrist what was seen on the retinal exam.  Ask if he/she thinks an ophthalmologist referral is indicated.  That would be a good start.  Even if a few drusen were noticed, that in itself would not be a major reason for alarm but it would be a good idea to have dilated retinal exam every year.

MJK MD