Clinicians frequently overlook IJRT as a cause of retinal edema, parafoveal hemorrhages and exudates. For diabetic or hypertensive patients, doctors often wrongly attribute the parafoveal findings to these diseases. Suspect IJRT when you note parafoveal hemorrhaging, particularly when there is no peripheral hemorrhaging in diabetics, or no systemic ischemic vascular disease.
Occasionally, you may observe the juxtafoveal telangiectasia on ophthalmoscopy. The parafoveal vessels may take an irregular course, like they’re being dragged toward the foveal avascular zone. Angiography will readily reveal the details.
The prognosis of IJRT is excellent. Most cases present only with several isolated, unexplained parafoveal dot and blot hemorrhages. Once you’ve ruled out diabetes, anemia and hypertension as possible causes, you can simply monitor the condition, particularly if vision is unaffected. In cases of unremitting macular edema, focal photocoagulation may help. Since no systemic conditions are associated with IJRT, you don’t need to refer to a primary care physician.
Many systemic diseases manifest in readily observable retinal vascular changes. By understanding the complexities of retinal vascular disease, you can take steps to reduce morbidity not only to the eye, but to the patient as a whole.
Dr. Sowka is an associate professor at the Nova Southeastern University College of Optometry. Dr. Kabat is an assistant professor there.
- Aiello LM, Rand LI, Briones JC, Wafai MZ, Sebestyen JC. Diabetic retinopathy in Joslin clinic patients with adult onset diabetes. Ophthalmology 1981, 88:619–623.
- Harris MI, Hadden WC, Knowles WC, Bennett PH. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in US population aged 20–74 years. Diabetes 1987, 36:523–534.
- Diabetic Retinopathy Study Research Group. Four risk factors for severe visual loss in diabetic retinopathy. The third report from the Diabetic Retinopathy Study. Arch Ophthalmol 1979, 97:654–655.
- Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical applications of the Diabetic Retinopathy Study (DRS) findings. DRS report number 8. Ophthalmology 1981, 88:583–600.
- Ferris FL, Podgor MJ, Davis MD. Macular edema in diabetic retinopathy study patients. Diabetic Retinopathy Study report number 12. Ophthalmology 1987, 94:754–760.
- Early Treatment Diabetic Retinopathy Study Group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 4. Int Ophthalmol Clin 1987, 27:265–272.