During a funduscopic exam, sharp disc margins and a yellowish-orange macula with a veins to arteries ratio of 3:2 are findings most consistent with which conclusion?

During a funduscopic exam, sharp disc margins and a yellowish-orange macula with a veins to arteries ratio of 3:2 are findings most consistent with which conclusion?

• A. Advise patient that she had normal exam
• B. Refer to ophthalmology for abnormal exam
• C. Order MRI of the brain
• D. Start treatment for glaucoma

Answer: (A)

The main idea here is that normal fundus appearance is indicated by intact optic nerve head, a healthy macula, and a typical retinal vessel relationship. Sharp disc margins mean the optic nerve head isn’t swollen or pale, which argues against conditions like papilledema or optic neuropathy. The macula appearing yellowish-orange is the usual color due to lutein and the absence of macular disease, edema, or exudates. A veins-to-arteries ratio of 3:2 shows the veins are larger than the arteries as expected in a normal retina. When these features occur together, they describe a normal funduscopic exam. So, no signs of acute pathology are present, and there’s no need for imaging or treatment at this time. If any of these findings were abnormal—disc margins blurred or pale, macula with edema or hemorrhages, or an AV ratio that was markedly widened or narrowed—that would prompt further evaluation or referral.

The main idea here is that normal fundus appearance is indicated by intact optic nerve head, a healthy macula, and a typical retinal vessel relationship. Sharp disc margins mean the optic nerve head isn’t swollen or pale, which argues against conditions like papilledema or optic neuropathy. The macula appearing yellowish-orange is the usual color due to lutein and the absence of macular disease, edema, or exudates. A veins-to-arteries ratio of 3:2 shows the veins are larger than the arteries as expected in a normal retina. When these features occur together, they describe a normal funduscopic exam.

So, no signs of acute pathology are present, and there’s no need for imaging or treatment at this time. If any of these findings were abnormal—disc margins blurred or pale, macula with edema or hemorrhages, or an AV ratio that was markedly widened or narrowed—that would prompt further evaluation or referral.