The International Classification The International Classification of Diabetic Retinopathyof Diabetic Retinopathy

Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales.Ophthalmology 2003Sep;110(9):1677-82.

The Classification of Diabetic The Classification of Diabetic RetinopathyRetinopathy

• Mild Nonproliferative Diabetic Retinopathy:Microaneurysm only

• Moderate Nonproliferative Diabetic Retinopathy

• Severe Nonproliferative Diabetic Retinopathy: 4, 2, 1

The Classification of Diabetic The Classification of Diabetic RetinopathyRetinopathy

• Severe Nonproliferative Diabetic Retinopathy:Microaneurysms and/or dot blot

hemorrhages more than 20 dots in 4 quadrant

Venous beading in 2 quadrantsIntraretina Microvascular Abnormalities

(IRMA) in 1 quadrant

The Classification of Diabetic The Classification of Diabetic RetinopathyRetinopathy

• Proliferative Diabetic Retinopathy:New vessels at the optic discNew vessels elsewhereVitreous hemorrhage

• Macular edemaExudate at macular area

Microaneurysm / dot blot hemorrhage

Flame-shaped hemorrhage

exudate

Macular edema

Cotton-wool spot

Mild venous beading

NVD

Vitreous hemorrhage

Key to DR screeningKey to DR screening

• Right or left eye?Right or left eye?• Optic disc: NVOptic disc: NV• Macula: exudateMacula: exudate• Vessels: venous beading, NVEVessels: venous beading, NVE• Background: H/MA, cotton-wool spots, Background: H/MA, cotton-wool spots,

exudate, vitreous hemorrhageexudate, vitreous hemorrhage