Recognizing Uncommon White Retinal Vasculopathy

Abstract

Unusual medical presentations present diagnostic challenges, and correct identification of such conditions represents advanced clinical proficiency. White retinal vessels fall into the category of uncommon ophthalmic findings. This paper reviews presentations of white retinal vasculopathy, the pathophysiology behind those conditions, and the limitations of current terminology. Introduction Health care providers move through a series of steps culminating in the passage of board examinations certifying a basic level of "competency". To achieve this end, initial passive didactic education is integrated with active clinical training and eventually supplanted by immersive patient care. Ultimately, licensure leads to independent practice, yet provider development does not stop there, and the learning curve of clinical knowledge continues, albeit on a flattened trajectory, throughout a career. The medical literature is silent on this accumulation of clinical expertise; however, this author estimates that an additional 5-10 years of experience are required after leaving a training program to master the subtle nuances of patient care, to achieve a thorough proficiency required to evaluate the preponderance of cases in a particular practice on any given day, and to gain an appreciation of the anatomical and physiological changes associated with long-term clinical follow-up care. Because of the extreme variability in pathological manifestations of biological systems, not every single disease entity can be taught to-or even partially absorbed by-students in any training program. Medical trainees are instructed in the recognition of the most common diseases and then-it is hoped-provided a framework for application of certain basic medical principles (case history, physical exam, medical decision-making) to unknown patient presentations. Eventually, clinical intuition develops with accumulated experience. There is no systematic path to advanced clinical knowledge. After structured clinical education is completed, providers are expected to research cases with findings new to them and to consult with colleagues to continue their clinical education-and most do. However, this process continues to be piecemeal-largely dependent upon the caseload of the provider-and the results are haphazard and inconsistent. This gradual attainment of medical knowledge over many years culminates in the attainment of advanced clinical experience but is not attained via a measurable endpoint.

Peripheral retinal vessel whitening in patients with diabetes mellitus

“…Retinal vessel whitening represents a final common pathway for several hypoxic processes and is thought to be a sequela of an ischemic event. The retinal vessels appear white due to the accumulation of material within the vascular lumen and resultant vascular wall ischemia, resulting in vascular endothelial cell death 9 . Development of retinal vessel whitening can occur in retinal arterioles and venules from vascular occlusion or thrombosis, respectively 9 .…”

“…The retinal vessels appear white due to the accumulation of material within the vascular lumen and resultant vascular wall ischemia, resulting in vascular endothelial cell death 9 . Development of retinal vessel whitening can occur in retinal arterioles and venules from vascular occlusion or thrombosis, respectively 9 . Retinal vessel whitening has also been associated with retinal arterial or vein occlusion (BRAO, BRVO), which can lead to visual loss.…”