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Diabetic Retinopathy Screening Services in Scotland: Recommendations for Implementation

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DIABETIC RETINOPATHY SCREENING SERVICES IN SCOTLAND: RECOMMENDATIONS FOR IMPLEMENTATION

Diabetic Retinopathy Screening: Annex E

Scottish Diabetic Retinopathy Grading Scheme 2003

Retinopathy

Description

Outcome

R0

No diabetic retinopathy anywhere

Rescreen 12 months

R1(mild)

Background diabetic retinopathy BDR - mild
• At least one dot haemorrhage or microaneurysm with or without hard exudates

Rescreen 12 months

R2(moderate)

BDR - moderate
• Four or more blot haemorrhages (i.e. >= AH standard photograph 2a) in one hemi-field only(Inferior and superior hemi-fields delineated by a line passing through the centre of the fovea and optic disc)

Rescreen 6 months
(or refer to ophthalmology if this is not feasible)

R3(severe)

BDR - severe Any of the following features:
• Four or more blot haemorrhages (i.e. >= AH standard photograph 2a) in both inferior and superior hemi-fields
• Venous beading(>=AH standard photograph 6a)
• IRMA(>= AH standard photograph 8a)

Refer ophthalmology

R4(proliferative)

Proliferative diabetic retinopathy PDR Any of the following features
• New vessels
• Vitreous haemorrhage

Refer ophthalmology

R5(enucleated)

Enucleated eye

Rescreen 12 months
(other eye)

R6(inadequate)

Not adequately visualised Retina not sufficiently visible for assessment

Technical failure
Arrange alternative screening examination

Maculopathy

Description

Outcome

M1(Observable)

Lesions within a radius of >1 but <- 2 disc diameters of the centre of the fovea
• Any hard exudates

Rescreen 6 months
(or refer to ophthalmology if this is not feasible)

M2(Referable)

Lesions within a radius of <- 1 disc diameter of the centre of the fovea
• Any blot haemorrhages
• Any hard exudates

Refer ophthalmology

Coincidental findings

Description

Outcome

Photo- coagulation

Laser photocoagulation scars present

Other

Other non-diabetic lesion present
• Pigmented lesion (naevus)
• Age-related macular degeneration
• Drusen maculopathy
• Myelinated nerve fibres
• Asteroid hyalosis
• Retinal vein thrombosis

Grading note

This grading scheme is not intended to be done by levels. It is meant to be done by features. The grader reports the presence or absence of each of the following features for each hemisphere and then derives the level for the individual eye:

  • Dot haemorrhages or microaneurysm

  • 4 or more blot haemorrhages (i.e. >= standard photography 2a)

  • Venous Beading (>= AH standard photograph 6a)

  • IRMA (>= AH standard photograph 8a)

  • New vessels

  • Vitreous haemorrhage

AH = Airlie House. Airlie House standard photographs available at: http://eyephoto.ophth.wisc.edu/ResearchAreas/Diabetes/DiabStds.htm