DOCSLIB.ORG

Title: Cotton Wool and Roth Spots As Ocular Complications of Cyclophophamide Treatment for Renal Disease

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Title: Cotton Wool and Roth Spots As Ocular Complications of Cyclophophamide Treatment for Renal Disease Kevin Chuang, O.D. Title: Cotton Wool and Roth Spots as Ocular Complications of Cyclophophamide Treatment for Renal Disease Abstract: A patient returning for follow up shows a large increase in retinal cotton wool spots and a Roth spot after initiation of cyclophosphamide treatment for renal disease. I. Case History Patient demographics: 61 year old Caucasian male. Chief complaint: 6 month follow up for RPE abnormalities and questionable cotton wool spot. Last eye exam: 6 months ago o Ocular History: RPE abnormalities, 1 cotton wool spot, refractive error Medical history: o Chronic rapidly progressive glomerulonephritis o Type 2 insulin dependent diabetes mellitus without complications o Hepatitis C o Obesity o Hyperlipidemia o Hypertension o Chronic obstructive pulmonary disease Medications: insulin, cyclophosphamide, furosemide, losartan, metoprolol tartrate, prednisolone Other salient information: not currently on treatment for hepatitis C II. Pertinent findings Clinical: o VAcc OD 20/20, OS 20/20 at D, OD 20/25, OS 20/25 at N o OD plano+0.75x007 BCVA 20/20, OS -0.25+0.50x153 BCVA 20/20 o Add +2.25 OD, OS, OU 20/20 at near o Pupils: equal, round, and reactive to light, no RAPD; all other entrance tests unremarkable o Anterior segment: . 1+ nuclear sclerotic cataracts OU o Posterior pole: . OD: flame shaped hemorrhage, 6 scattered CWS along arcades . OS: Roth spot, flame shaped hemorrhage, 7 scattered CWS along arcades Laboratory studies: o HbA1C: 5.7% 1 month ago o Blood pressure: 127/82mmHg 1 month ago Others: 1 Kevin Chuang, O.D. o Nephrologist: started patient on cyclophosphamide 5 months ago for progressive glomerulonephritis III. Differential diagnosis Primary/leading: o Chemotherapy induced ocular complication o Diabetic retinopathy o Hypertensive retinopathy o Others: o HIV retinopathy o Subacute bacterial endocarditis o Severe anemia IV. Diagnosis and discussion Elaborate on the condition: o Cotton wool spots are thought to arise from an interruption of axoplasmic flow from focal ischemia associated with occlusion of precapillary arterioles4. They are not specific to any specific disease process and are associated with many common and rare diseases. Cotton wool spots are most commonly associated with diabetes and malignant hypertension, yet they may also be associated with numerous other disorders such as HIV disease, leukemia or the use of chemotherapy agents. o Roth spots are white centered retinal hemorrhages. Previously thought to be pathognomonic for subacute bacterial endocarditis, they have now been shown to be not specific to any disease entity3. Roth spots may be observed in several conditions including blood dyscrasia and severe anemia. Expound on unique features: o The patient has never been on interferon treatment and physical exams indicate a history of well controlled diabetes and blood pressure. The large increase in the cotton wool spots and the new appearance of a Roth spot was observed on follow up after the patient was started on the chemotherapy alkylating agent cyclophosphamide for worsening renal disease. The potential of chemotherapy agents to cause retinopathy has been previously described and the observation of retinopathy in this patient is presumed to arise from the effects of the chemotherapy drug1,2. V. Treatment and Management Management: o Observation and follow up with dilated fundus exam every 4-8 weeks or sooner given any vision changes. 2 Kevin Chuang, O.D. o Discontinuation of cyclophosphamide may be indicated if cotton wool spots threaten the macula. VI. Conclusion Clinical pearls: o Cotton wool spots and Roth spots present a myriad of challenging differentials that can be narrowed down upon review of a patient's medications and medical history. References: 1. Khawly, J. A., Rubin, P., Petros, W., Peters, W. P., & Jaffe, G. J. (1996). Retinopathy and optic neuropathy in bone marrow transplantation for breast cancer. Ophthalmology, 103(1), 87-95. 2. Kende, G., Sirkin, S. R., Thomas, P. R., & Freeman, A. I. (1979). Blurring of vision: A previously undescribed complication of cyclophosphamide therapy. Cancer, 44(1), 69- 71. 3. Ling, R., & James, B. (1998). White-centred retinal haemorrhages (roth spots). Postgraduate Medical Journal, 74(876), 581-582. 4. Brown, G. C., Brown, M. M., Hiller, T., Fischer, D., Benson, W. E., & Magargal, L. E. (1985). Cotton-wool spots. Retina (Philadelphia, Pa.), 5(4), 206-214. 3 .
Load more

Recommended publications
  • Multimodal Imaging of Cotton Wool Spots in Branch Retinal Vein Occlusion
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Bern Open Repository and Information System (BORIS) Original Paper Ophthalmic Res 2015;54:48–56 Received: April 7, 2015 DOI: 10.1159/000430843 Accepted: April 20, 2015 Published online: June 12, 2015 Multimodal Imaging of Cotton Wool Spots in Branch Retinal Vein Occlusion a, b, e a, b, f a, b Marion R. Munk Gerlinde Matt Magdalena Baratsits a, b c a, d a, b Roman Dunavoelgyi Wolfgang Huf Alessio Montuoro Wolf Buehl a, b a, b Ursula Schmidt-Erfurth Stefan Sacu on behalf of the Macula Study Group a b c Department of Ophthalmology, Medical University of Vienna, Center for Medical Physics and Biomedical d e Engineering and Vienna Reading Center, Medical University of Vienna, Vienna , Austria; Department of f Ophthalmology, Inselspital, University Hospital Bern, Bern , and Department of Ophthalmology, University Hospital Zurich, Zurich , Switzerland Key Words er than on CF (0.26 ± 0.17 mm 2 vs. 0.13 ± 0.1 mm 2 , p < 0.0001). Ischemia · Cotton wool spots · Cystoid bodies · Argon The CWS area on SD-OCT and surrounding pathology such laser treatment · Retinal vein occlusion · Branch retinal as intraretinal cysts, avascular zones and intraretinal hemor- vein occlusion · Hypoperfusion · Optical coherence rhage were predictive for how long CWS remained visible tomography · Fluorescein angiography · Axoplasmic (r 2 = 0.497, p < 0.002). Conclusions: The lifetime and presen- debris · Multimodal imaging · Acute macular tation of CWS in BRVO seem comparable to other diseases. neuroretinopathy SD-OCT shows a higher sensitivity for detecting CWS com- pared to CF.
    [Show full text]
  • 27 Cardiovascular Disorders
    27 Cardiovascular Disorders ◆ Systemic Hypertension Effects of Systemic Hypertension on the Eye and Vision ◆ Hypertensive retinopathy ◆ Hypertensive choroidopathy ◆ Hypertensive optic neuropathy ◆ Central and branch retinal vein occlusion ◆ Retinal macroaneurysm ◆ Vitreous hemorrhage ◆ Subconjunctival hemorrhage ◆ Secondary effects ° Carotid disease—retinal arterial emboli ° Cerebrovascular accident—visual field loss ° Ischemic optic neuropathy ° Oculomotor cranial nerve palsies ° Cataract, glaucoma, age-related macular degeneration Hypertensive Retinopathy Hypertensive retinopathy is usually asymptomatic. In severe hypertension, how- ever, painless loss of vision may occur due to the development of vitreous or reti- nal hemorrhages, retinal edema, retinal vascular occlusion, serous retinal detach- ment, choroidal ischemia, or optic neuropathy. Fundus Features ◆ Focal or diffuse narrowing of retinal arterioles ◆ Increased vascular tortuosity ( Fig. 27.1 ) ◆ Arteriovenous nicking (nipping) ( Fig. 27.2 ) ◆ Retinal hemorrhages ( Fig. 27.3 ) ° Flame-shaped hemorrhage ° Dot and blot hemorrhage ° Preretinal hemorrhage ◆ Microaneurysms ◆ Hard exudates, macular star ◆ Cotton-wool spots (F igs. 27.4 and 27.5 ) ◆ Abnormality of vascular reflex ° Copper-wire reflex ( Fig. 27.6 ) ° Silver-wire reflex ( Fig. 27.7 ) ◆ Intraretinal microvascular abnormalities ◆ Retinal edema ( Fig. 27.8 ) ◆ Serous retinal detachment—occurs secondary to hypertensive choroidopathy in patients with very severe hypertension or eclampsia ( Fig. 27.9 ) ◆ Elschnig spots—small to medium-size hyper- and hypopigmented patches rep- resenting chorioretinal scarring due to prior choroidal infarction ( Figs. 27.10 and 27.11 ) 111 14585C27.indd 111 7/8/09 3:44:46 PM 112 III The Retina in Systemic Disease ◆ Siegrist streaks—linear configurations of hyperpigmentation that have a patho- genesis similar to that of Elschnig spots. ◆ Optic disc edema ( Fig. 27.12 ) ◆ Optic atrophy ◆ Vitreous hemorrhage Fig.
    [Show full text]
  • Hypertension and the Eye
    rnib.org.uk/gp [email protected] Hypertension and the eye This factsheet was produced under a collaboration between the UK Vision Strategy, RNIB, and the Royal College of General Practitioners. Key learning points • Hypertensive retinopathy is a clinical diagnosis made when characteristic fundus findings are seen in a patient with or who has had systemic arterial hypertension. • Mild hypertensive retinal features are seen commonly and are of limited relevance, advanced changes represent important signs of accelerated hypertension. • The main complications from hypertension are retinal artery and retinal vein occlusions, and these cause considerable visual morbidity. • Treatment of hypertension may resolve ocular features, but does not improve established vision loss. • Other vascular risk factors eg hyperglycaemia, dyslipidaemia, smoking and abnormal circulation compound the risk and effect of hypertension in the eye. Evidence base: common eye diseases are commoner if the patient is hypertensive • Cataract: In a meta-analysis of 25 studies across the world, risk of cataract was found to be increased in populations with hypertension independent of glycaemic risk, obesity or lipids [1]. We don’t know how generalisable this finding is. • Glaucoma: Nocturnal hypotension is also found to be associated with progression of visual field defects in glaucoma. • Late stage AMD: Some population studies show increased incidence with high © 2016 RNIB Reg charity nos 226227, SC039316 rnib.org.uk/gp [email protected] systolic BP [2], others show incidence associated with the metabolic syndrome but not specifically with hypertension [3]. • Other: Incidental retinal detachment in non-myopic eyes has been found to be more common [4] but again we don’t know how generalisable this is.
    [Show full text]
  • Cotton Wool Spots the Moral of the Story Brown Et Al
    Examining the Retina Assess the optic nerve Clinical Decisions in Retina What is the cup to disc ratio Is there good coloration and perfusion Mark T. Dunbar, O.D., F.A.A.O. Is it flat Choroidal or scleral crescent Mark Dunbar: Disclosure Examining the Retina Consultant for Allergan Pharmn What is the caliber of the retinal vessels Optometry Advisory Board for: Make sure you look and consciously take not of what the caliber is Allergan Carl Zeiss Meditec Narrowing of the vessels requires checking Alcon Nutritional the blood pressure Advisory Board Mark Dunbar does not own stock in any of the above companies Normal A/V ratio is 2/3, ¾ ArticDx What about the arterial light reflex? Examining the Retina Examining the Retina Don’t forget to look at the anterior vitreous The Macula Needs to be done on every dilated patient Is there a foveal light reflex (FLR)? Done at the slit lamp, looking posterior to Is it flat? the lens Is there any fluid, hemorrhage, or exudate Retroillumination may help if you suspect Presence of drusen vitreous cell RPE mottling More on this later Examining the Retina PVD The peripheral retina 65% of individuals > 65 have PVD It has to be done through a dilated pupil More common in women Don’t substitute imaging for indirect ophthalmoscopy More common following intraocular surgery Use Imaging as a compliment, but not substitute More common following Be systematic in your examination inflammation You should be able to see ora on “all” gazes More common in aphakes It’s all about technique
    [Show full text]
  • Public Health and the Eye
    SURVEY OF OPHTHALMOLOGY VOLUME 46 • NUMBER 1 • JULY–AUGUST 2001 PUBLIC HEALTH AND THE EYE DONALD FONG AND JOHANNA SEDDON, EDITORS Retinal Microvascular Abnormalities and their Relationship with Hypertension, Cardiovascular Disease, and Mortality Tien Yin Wong, FRCS, MPH,1,2,3 Ronald Klein, MD, MPH,1 Barbara E. K. Klein, MD, MPH,1 James M. Tielsch, PhD,3,4 Larry Hubbard, MAT,1 and F. Javier Nieto, MD, PhD3 1Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA, 2Singapore National Eye Center and Department of Ophthalmology, National University of Singapore, Singapore, 3Department of Epidemiology and 4Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA Abstract. Retinal microvascular abnormalities, such as generalized and focal arteriolar narrowing, arte- riovenous nicking and retinopathy, reflect cumulative vascular damage from hypertension, aging, and other processes. Epidemiological studies indicate that these abnormalities can be observed in 2–15% of the nondiabetic general population and are strongly and consistently associated with elevated blood pressure. Generalized arteriolar narrowing and arteriovenous nicking also appear to be irreversible long-term markers of hypertension, related not only to current but past blood pressure levels as well. There are data supporting an association between retinal microvascular abnormalities and stroke, but there is no convincing evidence of an independent or direct association with atherosclerosis, ischemic heart disease, or cardiovascular mortality. New computer-related imaging methods are currently being developed to detect the presence and severity of retinal arteriolar narrowing and other microvascular characteristics. When reliably quantified, retinal microvascular abnormalities may be useful as risk indi- cators for cerebrovascular diseases.
    [Show full text]
  • Cotton-Wool Spots and Retinal Light Sensitivity in Diabetic Retinopathy Br J Ophthalmol: First Published As 10.1136/Bjo.75.1.13 on 1 January 1991
    Britishournalofphthalmology, 1991,75, 13-17 13 Cotton-wool spots and retinal light sensitivity in diabetic retinopathy Br J Ophthalmol: first published as 10.1136/bjo.75.1.13 on 1 January 1991. Downloaded from Toke Bek, Henrik Lund-Andersen Abstract rapidly progressing retinopathy.2 Although it is In 14 eyes of 14 patients with diabetic retino- known that the cotton-wool spot can be caused pathy the light sensitivity of retinal cotton- by focal retinal ischaemia, no single explanation wool spots was studied by computerised has been given which consistently accounts for perimetry, and the visual field data were the aetiology of the lesion in all cases.3 accurately correlated with the corresponding The retinal cotton-wool spot has been mainly morphology as seen on fundus photographs investigated by photographic and histological and fluorescein angiograms. In 12 of the eyes techniques which demonstrate the morpho- the examinations were repeated within one logical aspects of the lesion. The inclusion of year in order to follow changes in retinal light techniques for the assessment of neurosensory sensitivity during the evolution of the lesions. function can be expected to supplement our Retinal cotton-wool spots were in all eyes understanding of its pathophysiology. In a prior associated with localised non-arcuate scoto- study the visual field of six diabetic patients with mata in the visual field. In four eyes the cotton- retinal cotton-wool spots was examined by a wool spots disappeared within three months of manual perimetric technique,4 but the exact the first examination, and in two ofthese cases correlation between visual field data and the the corresponding scotomata disappeared corresponding fundus morphology was not together with the morphological lesions.
    [Show full text]
  • Retinal Cotton-Wool Spots: an Early Finding in Diabetic Retinopathy?
    Br J Ophthalmol: first published as 10.1136/bjo.70.10.772 on 1 October 1986. Downloaded from British Journal of Ophthalmology, 1986, 70, 772-778 Retinal cotton-wool spots: an early finding in diabetic retinopathy? M S ROY,' M E RICK,2 K E HIGGINS,' AND J C McCULLOCH3 From the 'National Eye Institute, Clinical Branch, Retinal and Vitreal Disease Section; 2Clinical Center, Clinical Pathology Department, Hematology Service; and 3Department of Ophthalmology, Toronto, Canada SUMMARY Five insulin dependent diabetic patients are reported on who had a few small retinal cotton-wool spots or 'soft exudates' either totally isolated or associated with fewer than 10 microaneurysms. These observations suggest that cotton-wool spots may be an early finding in diabetic retinopathy. Significant biological abnormalities in these patients were high levels of glycosylated haemoglobin and mild increases in thrombin generation, indicating slight activation of the coagulation system. The possible significance of these clinical and biological findings is discussed. A prime aetiological agent in diabetic retinopathy areas of the retinal capillary bed. The exact time would appear to be chronic hyperglycaemia and the sequence of these two changes is unknown. As copyright. associated metabolic changes of diabetes mellitus.' retinopathy worsens in diabetic patients there is an However, the precise causes of both the onset and the increasing number of totally acellular capillaries development of the characteristic retinal changes which no longer carry blood.'" It has been suggested seen in diabetic patients are poorly understood. that, if complete occlusion of a precapillary arteriole Efforts are increasingly being directed at studying the in the superficial layers of the retina occurs suddenly, early stages of diabetic retinopathy in an attempt to a cotton-wool spot is seen on clinical examination of find a clue to its pathogenesis.
    [Show full text]
  • Unilateral Cotton Wool Spots: an Important Clue
    THE CLINICAL PICTURE THANIGAIARSU THIYAGARAJAN, MD HUSSAM ELKAMBERGY, MD VIJAY MAHAJAN, MD PRIYA KUMARAGURU, MD Department of Internal Medicine, St. Vincent Mercy St. Vincent Mercy Medical Center, Program Director, Department of Internal St. Vincent Mercy Medical Center, Medical Center, Toledo, OH Toledo, OH Medicine, St. Vincent Mercy Medical Toledo, OH Center, Toledo, OH The Clinical Picture Unilateral cotton wool spots: An important clue 54-year-old man presents with sudden visual A loss in the left eye. The left eye and left perior- bital area have been painful for the past 5 days. Funduscopic examination of the left eye reveals multiple cotton wool spots in the peripapillary area (FIGURE 1). The visual acuity is 20/200. The right eye appears normal, with normal vision. Duplex ultrasonography of the carotid arteries shows total occlusion of the left internal carotid ar- tery. Fluorescein angiography of the fundus reveals focal hyperfluorescence with delayed arteriovenous transit time in the left eye. Q: Which of the following diagnoses is the most likely at this point in the evaluation? □ Hypertensive retinopathy FIGURE 1. Multiple cotton wool spots in the peri- □ Diabetic retinopathy papillary area in the left eye. □ Human immunodeficiency virus (HIV) retinopathy □ Retinal involvement of systemic autoimmune disease ■ USUAL SIGNS AND SYMPTOMS □ Ocular ischemic syndrome Usually, the patient presents with visual loss that has A: The ocular symptoms of hypertension, diabetes mel- progressed gradually over a period of weeks or months litus, HIV infection, and other autoimmune diseases and is associated with dull aching in the eye or orbit usually present bilaterally, and funduscopic examina- (“ocular angina”).3 Cotton wool spots on funduscopic tion often reveals other signs such as vessel tortuosity, examination represent retinal nerve fiber layer infarcts, venous dilation, microaneurysms, retinal hemorrhages, a sign of retinal hypoperfusion.
    [Show full text]
  • The Microperimetry of Resolved Cotton-Wool Spots in Eyes of Patients with Hypertension and Diabetes Mellitus
    CLINICAL SCIENCES The Microperimetry of Resolved Cotton-Wool Spots in Eyes of Patients With Hypertension and Diabetes Mellitus Jae Suk Kim, MD; Anjali S. Maheshwary, MD; Dirk-Uwe G. Bartsch, PhD; Lingyun Cheng, MD; Maria Laura Gomez, MD; Kathrin Hartmann, MD; William R. Freeman, MD Background: Retinal cotton-wool spots (CWSs) are an were imaged. The mean (SD) sensitivity of resolved CWSs important manifestation of retinovascular disease in hy- in the eyes of patients with HTN and DM was 11.67 (3.88) pertension (HTN) and diabetes mellitus (DM). Conven- dB and 7.21 (5.48) dB, respectively. For adjacent con- tional automated perimetry data have suggested relative trol areas in the eyes of patients with HTN and DM, the scotomas in resolved CWSs; however, this has not been mean (SD) sensitivity was 14.00 (2.89) dB and 11.80 well delineated using microperimetry. This study evalu- (3.45) dB, respectively. Retinal sensitivity was signifi- ates the retinal sensitivity in documented resolved CWSs cantly lower in areas of resolved CWSs than in the sur- using microperimetry. rounding controls for patients with HTN (P=.01) and those with DM (PϽ.001). Scotomas in patients with DM Methods: Retinal CWSs that resolved after 10 to 119 were denser than those of patients with HTN (PϽ.05). months (median, 51 months) and normal control areas were photographed to document baseline lesions. Eye- Conclusions: Cotton-wool spots in patients with DM and tracking, image-stabilized microperimetry with simulta- HTN leave permanent relative scotomas detected by mi- neous scanning laser ophthalmoscopy was performed over croperimetry.
    [Show full text]
  • Why Cotton Wool Spots Should Not Be Regarded As Retinal Nerve Fibre Layer Infarcts
    229 Br J Ophthalmol: first published as 10.1136/bjo.2004.058347 on 21 January 2005. Downloaded from PERSPECTIVE Why cotton wool spots should not be regarded as retinal nerve fibre layer infarcts D McLeod ............................................................................................................................... Br J Ophthalmol 2005;89:229–237. doi: 10.1136/bjo.2004.058347 Cotton wool spots (CWSs) comprise localised its axon. For several days after localised axonal damage, both orthograde and retrograde axo- accumulations of axoplasmic debris within adjacent plasmic transport will continue unabated in bundles of unmyelinated ganglion cell axons. Their undamaged axon segments causing axon end formation is widely held to reflect focal ischaemia from bulbs to appear on each side of the point of injury. When large clusters of cytoid bodies arise terminal arteriolar occlusion, but credible evidence in this way, they will expand the retinal nerve supporting this view is lacking. CWSs are here purported fibre layer (RNFL) and may protrude into the to be nothing more than sentinels of retinal nerve fibre vitreous (fig 2). layer pathology, hence their recommended redesignation ‘‘cotton wool sentinels.’’ After branch arteriolar occlusion, THE PREVAILING VIEWPOINT: ‘‘THE FOCAL ISCHAEMIA HYPOTHESIS’’ CWSs evolve as boundary sentinels of infarction, their Look at most textbooks, periodicals, or websites uniform width suggesting a glial constraint to axonal and you will find that CWSs are perceived to be expansion. In pre-proliferative diabetic retinopathy, CWSs synonymous with focal retinal ischaemia, a view promulgated since the middle of the last form a C-shaped chain nasal to the disc and around the century.4 Thus, CWSs are often construed as macula where they constitute sentinels of ischaemia microinfarcts occupying the downstream terri- affecting the entire retinal mid-periphery.
    [Show full text]
  • The Mystery of Cotton-Wool Spots a Review of Recent and Historical Descriptions
    June 24, 2008 EU RO PE AN JOUR NAL OF MED I CAL RE SEARCH 231 Eur J Med Res (2008) 13: 231-266 © I. Holzapfel Publishers 2008 Review THE MYSTERY OF COTTON-WOOL SPOTS A REVIEW OF RECENT AND HISTORICAL DESCRIPTIONS Dieter Schmidt Univ.-Augenklinik Freiburg, Germany Abstract amaurosis fugax attack. Therefore, every patient who Purpose: Cotton-wool spots (CWSs) lie superficially as notices floaters or a brief visual disturbance, possibly opaque swellings in the retina, with occurring as acute a significant predictor of disease, should be examined lesions. The occurrence of CWSs is a sign of serious ophthalmoscopically. vascular damage. The detection of CWSs at an early stage is neces- Methods: CWSs can usually be diagnosed by ophthal- sary, because they could be the first sign of a systemic moscopy. In the literature, there are reports of exami- disease. Even an isolated CWS should alert a clinician nations by fluorescein angiography, visual fields, or to arrange an extensive examination of the patient. optical coherence tomography (OCT). The occurrence of CWSs is usually a serious sign of Results: CWSs are non-specific, as they can occur in vascular damage (Andersen, 1978) [1]. different diseases involving the retinal vascular system. CWSs are localized accumulations of axoplasmic de- I. DEFINITION OF COTTON-WOOL SPOTS bris within adjacent bundles of ganglion cell axons. They occur after arteriolar occlusion at the borders of There are several terms in the literature for "cotton- large ischemic areas, and should not be regarded as wool spots" (CWSs) or "cotton-wool patches", such as retinal fiber layer infarcts (McLeod).
    [Show full text]
  • Detection and Classification of Cotton Wool Spots in Diabetic Retinopathy
    International Journal of Recent Technology and Engineering (IJRTE) ISSN: 2277-3878, Volume-8 Issue-3, September 2019 Detection and Classification of Cotton Wool Spots in Diabetic Retinopathy S.Sudha, A.Srinivasan, T.Gayathri Devi Abstract- Diabetes is a disorder that occurs when blood sugar of sensitivity, specificity and accuracy. Finally author has level increases. Further increase of blood glucose lead to serious concluded that feature based segmentation is the extent for complications and it will affect major organs of our body. Diabetes improving the accuracy. The proposed method [2] focused on affects both of the eyes called Diabetic Retinopathy (DR). If it is combined features to train deep neural network with the treated properly eye blindness can be prevented. The main objective of this paper is to detect Cotton Wool Spots (CWS) using approach of Boltzmann machines. Author suggested this morphological operations and the spots are segmented using techniques because of speed and accurate. The author has k-means segmentation. Distinct features are extracted from the reviewed [3] recent algorithms used for the detection of early segmented image to train and test the Support Vector Machine stage lesions in diabetic retinopathy. The input image is (SVM) classifier. It is used to classify the lesions and the stages of pre-processed [4] to extract green channel component and diabetic retinopathy. It is noticed that sensitivity is 95% and the quality enhancement. Fuzzy C means clustering algorithm is specificity is 86%. used to extract dark & bright points in the image. Optic disk Keywords- Diabetic Retinopathy; cotton wool spots; Support & blood vessels are eliminated to point out Microaneurysms, Vector Machine (SVM); Morphological operations.
    [Show full text]