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Diabetic Retinopathy

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Diagnosis 3 Table 1. Diabetic Retinopathy Disease Severity Scale and International Clinical Diabetic Retinopathy Disease Severity Scale Disease Severity Level Findings Observable Upon Dilated Ophthalmoscopy No apparent retinopathy No abnormalities Mild NPDR Microaneurysms only Moderate NPDR More than just microaneurysms but less than severe NPDR Severe NPDR U.S. Definition Any of the following (4-2-1 rule) and no signs of proliferative retinopathy: • Severe intraretinal hemorrhages and microaneurysms in each of four quadrants • Definite venous beading in two or more quadrants • Moderate IRMA in one or more quadrants International Definition Any of the following and no signs of proliferative retinopathy: • >20 intraretinal hemorrhages in each of four quadrants • Definite venous beading in two or more quadrants • Prominent IRMA in one or more quadrants PDR One or both of the following : • Neovascularization • Vitreous/preretinal hemorrhage IRMA, intraretinal microvascular abnormalities; NPDR, nonproliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy Note: • Any patient with two or more of the characteristics of severe NPDR is considered to have very severe NPDR. • PDR may be classified as high-risk and non-high-risk. See Table 8 for more information. Adapted with permission from Wilkinson CP, Ferris FL III, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmolog y 2003;110:1679.

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