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Introduction
Screening Schedule and Flow Chart
How the Eye Photo Service Works
How to Find Us
How to Grade Diabetic Retinopathy
Before Sending a Patient
Why Screen for Diabetic Retinopathy?
Retinal Photography for Diabetic Retinopathy Screening
More Resources

How to Grade Diabetic Retinopathy

Grading of retinal photographs for clinical decision-making

Non proliferative diabetic retinopathy (NPDR)
Mild Microaneurysms only, in 1 - 3 quadrants
Moderate More than just microaneurysms but less than severe NPDR
Severe Any of the following:
  • Microaneurysms in all 4 quadrants
  • Venous beading in at least 2 quadrants
  • Prominent intraretinal microvascular abnormality (IRMA) in at least 1 quadrant
Proliferative diabetic retinopathy (PDR) Any of the following:
  • Abnormal new vessels (neovascularization)
  • Vitreous haemorrhage
  • Preretinal haemorrhage
Advanced diabetic eye disease Any of the following:
  • Fibrovascular tissue proliferation
  • Retinal dragging
  • Retinal detachment
Diabetic maculopathy Hard exudates at the macula
Retinal thickening at the macula
Non gradeable images Poor quality images
Third order retinal vessel branching not clearly visible

References:
  1. CPG for the Screening of Diabetic Retinopathy, June 2011, MOH/P/PAK/216.11(GU)
  2. Preferred Practice Pattern on Diabetic Retinopathy 2008, American Academy of Ophthalmology

Download “A quick guide to reviewing diabetic retinal photographs” reference card