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CASE NO. 8B
V.2013

SCOTT SOMMER

CLINICAL PRESENTATION:
BLURRING OF VISION

CASE AUTHOR:

VICTORIO CAJITA, M.D.

Department of Ophthalmology
Cebu Institute of Medicine
F. Ramos Street, Cebu City
Tel. (032) 253-3124
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SCOTT SOMMER Case No. 8B

Facilitator’s Copy

Patient Information:

SCOTT SOMMER is a 64 yr old male, a German national but has been living in Cebu City for
the past 3 years. He is complaining of painless blurring of vision of both eyes for several
months already. He has been a non-insulin dependent diabetic for about 10 yrs with poor
control of his blood sugar.

TASKS:

1. Identify SCOTT SOMMER’s problem.

2. What additional clinical information are needed relating to the patient’s problem?
3. Discuss the different possible mechanisms leading to painless blurring of vision.
4. State your differential diagnosis.
5. List down learning issues.

DO NOT GO TO THE NEXT PAGE UNTIL THE TASKS HAVE BEEN DISCUSSED.
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SCOTT SOMMER Case No. 8B

Facilitator’s Copy

P.E.:

Ophthalmologic Exam:

V.A. pinhole
OD 20/200 20/70
OS 20/100 20/40

Adnexae: OU no conjunctival congestion, anicteric sclerae, no

Discharge

Slit lamp biomicroscopy:

OU clear cornea, formed anterior chamber, reactive
pupils, mild cortico-nuclear lens opacities

Applanation tonometry: OU 18mmHg

Motility: full EOM’s

Funduscopy: dull ROR, distinct disc borders, CD ratio 0.3, mild

venous tortuousity, dilatation and beading, scattered dot-blot
retinal hemorrhages, few cotton wool spots, hard exudates in
the posterior pole affecting the fovea, no foveal reflex

TASKS:

1. Identify the significant findings in the ophthalmologic exam.

2. Reorganize problem and hypothesis list.
3. Discuss natural history of the disease.
4. Outline diagnostic and therapeutic management.
5. Discuss possible complications and outcome.
6. List down additional learning issues.

DO NOT GO TO THE NEXT PAGE UNTIL THE TASKS HAVE BEEN COMPLETED.
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SCOTT SOMMER Case No. 8B

Facilitator’s Copy

Additional Information:

Management:
A. Diagnostics
1. Flourescein angiography showed intraretinal dye leakage from multiple
microaneurysms, intraretinal microvascular abnormalities (IRMA), and dilated
perifoveal capillaries. There is also extensive capillary non-perfusion areas in
the mid-peripheral retina.
2. Optical coherent tomography showed thickening of macula with cystic space
in the mid-sensory retinal layers.

B. Therapeutic
1. referral to internist for diabetic control and treatment of other medical
problems if present
2. focal or grid macular laser treatment
3. panretinal laser photocoagulation (optional) depending on progression to
proliferative stage on subsequent visits
4. intravitreal injection of anti-vascular endothelial growth factors (VEGF) e.g.
pegaptanib (macugen), ranibizumab (lucentis), bevazizumab (avastin); or
steroids (triamcinolone acetonide)

C. Supportive
1. good diabetes control
2. exercise
3. no smoking
4. control of other medical problems
_______________________________________________________

TASKS:
1. Briefly discuss the rationale and mechanics of the diagnostic tests done.
2. Discuss the rationale of treatment: laser and medications.
3. List down additional learning issues to be raised during the wrap-up lecture.

END OF CASE
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COURSE OBJECTIVES:

1. Review the gross and microscopic anatomy of the eye.

2. Discuss the mechanism of vision propagation starting from light entering the cornea up
to image formation in the visual cortex.
3. Discuss the pathophysiologic mechanisms of painless blurring of vision.
4. Review the basic techniques of ophthalmologic examination (VATEF: visual acuity,
adnexae, tonometry, extraocular movements and funduscopy).
5. Discuss other simple ophthalmologic tests e.g., pinhole test, confrontation test, pupil
reflex tests.
6. Differentiate the signs and symptoms of various possible diseases presenting with
painless blurring of vision according to the part of the optical/visual pathway affected.
7. Discuss signs and symptoms of various forms of retinal diseases especially diabetic
retinopathy.
8. Discuss the various ancillary imaging tests that aid in the diagnosis of retinal diseases.
9. Discuss the management of various forms of retinal diseases and rationale of treatment.
10. Identify the cases presenting with painless blurring of vision that may need immediate
referral to specialists.