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A 40-year-old woman with a BMI of 30 presents with new floaters in her vision. Why?

NursingSKL clinical tip

By NursingSKL
June 12, 2023
iStock/ajr_images; NursingSKL

One of the most common causes of new floaters is the presence of new blood vessels related to diabetes. Patients with retinal changes suggestive of diabetic retinopathy may have known diabetes, or this may be their first presentation with the disease.

Patients with diabetes should be closely monitored for the development of diabetic retinopathy. Patients with type 1 should typically be assessed at five years after diagnosis, but patients with type 2 diabetes need to be screened for eye disease at the time of diagnosis as many will have diabetic changes.

This patient presented with new floaters. Vision from this eye was 6/15. Dilated retinal examination demonstrated a number of intraretinal hemorrhages. In addition, there was a collection of new blood vessels growing on the retinal surface (growing at the interface of the vitreous and retina). A microscopic vitreous hemorrhage was also noted (this is the cause of the new floaters).

As a nurse, it is important to remember that patients with diabetes can develop both macrovessel changes (coronary artery and carotid artery disease) as well as microvascular disease. Microvascular disease is the cause of peripheral neuropathy, retinopathy, and nephropathy. When assessing patients who are known to have diabetes, ask about vision changes and floaters; pins and needles or peripheral weakness; swelling of ankles, tiredness, increased peeing and blood in the urine.

Additionally, because many patients do not have a primary care physician, undiagnosed diabetics may now present with symptoms related to microvascular changes. It is very important to think about the possibility of undiagnosed diabetes if patients present with symptoms linked to heart disease, stroke/transient ischemic attack (TIA), retinopathy, neuropathy or nephropathy.

Clinical tip: In a patient presenting with symptoms suggestive of retinopathy, peripheral neuropathy or nephropathy, think of the possibility of previously diagnosed or undiagnosed diabetes.


In this video, you will learn the screening guidelines for diabetic eye disease so that your patient can prevent potentially blinding complications from diabetic retinopathy.

This clinical tip was provided by NursingSKL, a collaborative initiative between leading doctors and nurses to improve nurses’ clinical skills. Go to to find out more, meet the faculty, and try our free Practicum on Diabetes Care.
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