Moderate Hypertensive Retinopathy

Fundus photograph and red-free image (right eye)

Retinal photos show arteriolar narrowing with some copper wiring and arteriovenous crossing changes. Hard exudates are present between the optic disc and macula.

Also of note are the arcuate and wedge-shaped RNFL defects superiorly and inferiorly in this eye, likely related to retinal ischaemia during episodes of elevated blood pressure.

Fundus photograph and red-free image (left eye)

Retinal photos show generalised arteriolar narrowing and arteriovenous crossing changes, most notable along the inferior vascular arcade. There are hard exudates present between the optic disc and macula.

Spectralis OCT line scan (right macula)

OCT shows the presence of hard exudates near the right optic disc. The hard exudates appear as hyper-reflective foci on OCT, located in the outer plexiform and inner nuclear layers. There is no apparent intraretinal oedema associated with the hard exudates, suggesting the hard exudates have been present for some time.

Fundus photograph (right eye)

Retinal photos show mild copper wiring and arteriovenous nipping in the right eye. Cotton wool spots and haemorrhages can be seen at the superior vascular arcades and there is a small cotton wool spot infero-nasal to the macula.

Fundus photograph (left eye)

Retinal photos show a cotton wool spot in the superior vascular arcade and a larger one adjacent to the inferior vascular arcade. A flame (splinter) haemorrhage is also present inferiorly. Generalised arteriolar narrowing and arteriovenous crossing changes are also present.

OCTA (Superficial vascular plexus, 6 x 6mm left eye)

OCT angiography shows an area of capillary dropout inferotemporal to the left optic disc. This corresponds to the location of the cotton wool spot seen in the retinal photos.