Visual Difficulty after Switching to Contact Lenses | Figure 1

Visual Difficulty after Switching to Contact Lenses

A 25-year-old nephrology fellow decided to switch from glasses to semi-permeable contact lenses. At first, the transfer went smoothly. But after about two weeks of daily use, he started to have occasional vision problems. He had to move his head or eyes to bring some items into focus, which he thought might be because of problems with his new contact lens prescription. He was made an appointment with an ophthalmologist for more tests.

The specialist discovered retinal hemorrhages during the eye exam and immediately sent him to an endocrinologist for a full evaluation. Physical exam revealed a body weight of 220 pounds and a BMI of 31.6. Blood tests showed a hemoglobin A1C of 9.4%, and a fasting blood glucose level of 185 mg/dL. These findings strongly suggested a new diagnosis of diabetes mellitus with early diabetic retinopathy, manifesting as retinal hemorrhages.

The endocrinologist initiated a treatment strategy that included strict glycemic control, medical nutrition therapy, and a systematic weight loss program. Over the next few months, following dietary advice, losing weight, and keeping blood sugar levels in check led to a slow resolution of the retinal hemorrhages. Vision improved as the hemorrhages disappeared. This case emphasizes the potential benefit of prompt ophthalmologic evaluation for novel or unexplained visual alterations, particularly in young adults with undiagnosed diabetes mellitus, and illustrates the significance of interprofessional teamwork in the early identification and management of diabetic sequelae.

Diagnosis

Diabetic retinal hemorrhages

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