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180: I’ve just started my first position as an eye specialist in an eye practice in a shopping mall. I saw a 20-year-old female with a long history of type 1 diabetes. She told me she has two reviews with her general practitioner per year and the last one was one month ago when her blood sugar levels were in the normal range. When I examined her retinas both had what looked like soft exudates. There was no one else in the practice to ask for advice. She is coming back next week for a review when a more experienced specialist will be in the practice. The image shows her right retina. The left was the same. What is going on?

I have looked at the image and to me, it looks the ‘soft exudates’ are actually a reflection of the light from your ophthalmoscope or your camera. Healthy retinas are shiny and light used to examine them is reflected back from some parts of the retina into the observation device. While all the retina is healthy the refection comes from only some parts of it. This must be due to the curvature of the eye and the alignment between the retina and the observation device. Repeated observation or photographs will result in different parts of the retina shining. This is a normal occurrence. This pale shine can be mistaken for pathology, and typically pale soft exudates, by people who are starting out as eye specialists. This is okay and is part of the learning process. In my experience mistakes make the best teachers.

The retinal shine means that the layers of the retina have a normal structure, everything is where it should be and everything is working, as it should be. As people age, the retina often loses its shine. An older eye without this shine can still be healthy but just old. I would expect a 20-year-old to still have this shine.

This retinal shine is often referred to as a ‘sheen’ with means ‘to shine softly’.

Let the more experienced eye specialist review the patient next week. I’m sure they will confirm my suggestion that what you have seen in the photograph is the shine of a very healthy retina.

As the adage goes, every day is a school day.


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