CASE
A 54 year old female presents to your office for an eye check-up. She has not seen an optometrist in over 10 years, and never required glasses or had any problems with her eyes. She has no specific concerns.
The patient tells you she is otherwise healthy, although again she has not seen a medical doctor in over 10 years. She is on no medications and has no allergies to medications. Family history is unremarkable.
On exam best-corrected visual acuity is 20/40 bilaterally. Pressures are normal at 12 and 13 in the right and left eyes, respectively. Anterior segment exam is normal in both eyes. On dilated fundoscopy of the right eye, the following fundus image is seen. A similar appearance is seen in the left eye.
What is the most likely diagnosis?
Diabetic retinopathy INCORRECT
Although diabetic and hypertensive retinopathy may appear similar (and often coexist), the fundus appearance is more typical of hypertensive retinopathy, especially with the degree of arteriolar narrowing and lack of hemorrhages.
Hypertensive retinopathy CORRECT
AIDS retinopathy INCORRECT
AIDS retinopathy is the most common posterior segment finding in HIV+ patients, and presents typically with cotton wool spots and retinal hemorrhages, neither which are seen in this fundus photo. There are also no clues in the history to suggest this patient is HIV+.
Cat Scratch Disease INCORRECT
Cat scratch disease is a disease caused by the Bartonella bacteria commonly spread by scratches or bites from cats. Cat scratch disease has several ocular manifestations including granulomatous conjunctivitis and neuroretinitis. However it is more common in children and would not cause all fundus changes seen in the photograph.