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May be asymptomatic. Often presents with slowly progressive, mild blurring of vision.
Signs are usually, but not invariably, unilateral. Diabetic papillopathy may be an incidental finding in an asymptomatic patient. Visual acuity is often mildly reduced or normal, with or without an enlarged blind spot. Optic disc swelling may be striking, with distended surface vessels. There is not the pale swelling or atrophic appearance of anterior ischaemic optic neuropathy. Signs of diabetic macular oedema are often present. Cotton-wool spots and other signs of severe retinal ischaemia are uncommon.
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