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A 55-year-old patient is referred to you from the diabetic clinic for an “abnormal finding” on a tele-retinal diabetic screening examination. The patient has had previous panretinal photocoagulation (PRP), but denies any recent visual changes.

1.	Which of the following examination techniques would help you in your differential diagnosis?
	d -- all of the above Merely looking at the photograph, you would be concerned that the diabetic patient may have had a vitreous hemorrhage (though it would be old because the vitreous opacities are white).  On slit lamp examination and dilated fundus examination, along with actually visualizing the vitreous opacities, you would look for signs of proliferative diabetic retinopathy (neovascularization of the iris, optic disc, or retina, or pre-retinal heme). If the opacities were so numerous that you were unable to get a satisfactory view of the retinal structures, both ultrasound and fluorescein angiogram (FA) would be useful adjuvant to establish your diagnosis.  An ultrasound would not only be useful in characterizing the vitreous debris, but it would also be able to detect any underlying areas of tractional retinal detachment and possibly tufts of neovascularization. An FA could help you visualize underlying retinal pathology.
2.	If you saw asteroid hyalosis on slit lamp examination, which of the following would you expect to find?
	e -- areas of high reflectivity in the vitreous The patient has asteroid hyalosis, a condition where there are calcium soaps suspended in the vitreous.  You would expect to see areas of HIGH reflectivity in the vitreous on B-scan.
3.	If this patient had asteroid hyalosis, how would you treat this condition?
	a -- observation Asteroid hyalosis is more common in older patients and in those with hypertension or diabetes.  This condition rarely affects vision and should be observed in a patient with no visual complaints.