Clinicians frequently overlook IJRT as a cause of retinal edema, parafoveal hemorrhages and exudates. For diabetic or hypertensive patients, doctors often wrongly attribute the parafoveal findings to these diseases. Suspect IJRT when you note parafoveal hemorrhaging, particularly when there is no peripheral hemorrhaging in diabetics, or no systemic ischemic vascular disease.

Occasionally, you may observe the juxtafoveal telangiectasia on ophthalmoscopy. The parafoveal vessels may take an irregular course, like they’re being dragged toward the foveal avascular zone. Angiography will readily reveal the details.

The prognosis of IJRT is excellent. Most cases present only with several isolated, unexplained parafoveal dot and blot hemorrhages. Once you’ve ruled out diabetes, anemia and hypertension as possible causes, you can simply monitor the condition, particularly if vision is unaffected. In cases of unremitting macular edema, focal photocoagulation may help. Since no systemic conditions are associated with IJRT, you don’t need to refer to a primary care physician.

Many systemic diseases manifest in readily observable retinal vascular changes. By understanding the complexities of retinal vascular disease, you can take steps to reduce morbidity not only to the eye, but to the patient as a whole.

Dr. Sowka is an associate professor at the Nova Southeastern University College of Optometry. Dr. Kabat is an assistant professor there.

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