You are a junior doctor working in the diabetes outpatient clinic of a metropolitan hospital.

Yiannis Georgiou, a 61-year-old musician with type 2 diabetes for 14 years, has been sent to the clinic by the GP for review of poor glycaemic control and six months of gradually blurred vision, worse in the right eye. Fundus photographs were taken by the clinic's retinal camera today and are described for you below, together with the visual acuities and recent results. The patient is sitting with you and would like to know what the pictures show.

Fundus photographs (non-mydriatic retinal camera) and visual acuity

Fundus photographs (non-mydriatic retinal camera) and visual acuity

Item	Value	Reference range
Visual acuity, right eye	6/12, no improvement with pinhole	6/6
Visual acuity, left eye	6/9, improving to 6/6 with pinhole	6/6
Left eye: red reflex	Clear	Clear
Left eye: disc	Normal colour, margins and cup; no abnormal vessels	Normal
Left eye: vessels	Normal calibre; no beading	Normal
Left eye: macula	Normal foveal reflex; no deposits within two disc diameters of the fovea	Normal
Left eye: periphery	About a dozen tiny red dots and small dot haemorrhages, mostly nasal to the disc; two small clusters of waxy yellow deposits in the far periphery; no fluffy white patches	None

Recent bloods (GP, 2 weeks ago): HbA1c 9.5% (80 mmol/mol); eGFR 62 mL/min/1.73m2; urine albumin-creatinine ratio 8 mg/mmol; total cholesterol 5.6, LDL 3.4, HDL 1.0, triglycerides 2.8 mmol/L.

• You do NOT need to take a history or examine the patient; the relevant information is provided.

This is a 10-minute station, with 2 minutes of reading time.