Cotton wool spots on fundus are most strongly associated with which condition?

• A. Retinal detachment
• B. Age-related macular degeneration
• C. Optic neuritis
• D. Diabetes

Answer: (D)

Cotton wool spots are fluffy white patches on the retina that reflect microinfarcts in the retinal nerve fiber layer due to ischemia. This pattern arises most strongly in diabetes because chronic hyperglycemia damages retinal microvasculature, leading to capillary occlusion and nerve fiber layer ischemia, which shows up as these cotton-wool spots alongside other diabetic retinopathy changes. They’re not typical of retinal detachment, which presents with sudden vision loss and usually a visible detachment or curtain effect; nor of age-related macular degeneration, which features drusen, geographic atrophy, or neovascularization; nor of optic neuritis, which centers on optic nerve inflammation and disc changes.