HISTORY: This is the initial consultation for this pleasant 52?year?old lady referred by the primary care physician for diabetic eye exam. The patient says that she was first diagnosed with diabetes when she was 23 years old. It is not clear that she was continuously under the diagnosis of diabetes. She does complain of difficulty with her glasses. She is being treated with oral medications. She says that her blood sugars are good during the week but greater than 300 on weekends. She says that she does not watch her diet very well on weekends. She has a history of schizoaffective disorder for 10 years without treatment. She says that she did get treatment after that. Her medical history also includes hypothyroidism, and she is being treated for hypertension.

PHYSICAL EXAMINATION: On exam today, the vision with her reading glasses held close to her face is 20/25 in each eye. External exam is clear. Extraocular movements are full. Conjunctivae are clear. Corneas are clear. Anterior chambers are moderately deep and clear. No rubeosis. Intraocular pressure is 15 in each eye.

Dilated exam shows a well-positioned posterior chamber implant in each eye. She has mild capsular opacification in each eye, slightly more in the right eye than in the left. Dilated retinal exam shows no diabetic retinopathy. I got a clear look at the retinas. Maculas are normal. Discs are normal with physiological cups.

DIAGNOSES:
1. No diabetic retinopathy.
2. Mild capsular opacification.
3. Bilateral pseudophakia.
4. Presbyopia.

PLAN: I discussed the situation with her. I explained that her blood sugar at a level greater than 300 can cause blurring of the vision. I also told her about early capsular opacification, which does not require treatment at this time. She will stabilize her blood sugars and get new glasses as appropriate. I will have her back in six months for recheck on the capsular opacification.