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International Clinical Diabetic Retinopathy and Diabetic Macular Edema Disease Severity Scales

The levels in this new diabetic retinopathy disease severity scale consist of five scales with increasing risks of retinopathy.

International Clinical Diabetic Retinopathy Disease Severity Scale
Proposed Disease Severity Level Findings Observable upon Dilated Ophthalmoscopy
No apparent retinopathy No abnormalities
Mild nonproliferative diabetic retinopathy Microaneurysms only
Moderate nonproliferative diabetic retinopathy More than just microaneurysms but less than severe NPDR
Severe nonproliferative diabetic retinopathy Any of the following:
More than 20 intraretinal hemorrhages in each of four quadrants
Definite venous beading in two or more quadrants
Prominent IRMA in one or more quadrants
And no signs of proliferative retinopathy
Proliferative diabetic retinopathy

One or both of the following:

Neovascularization

Vitreous/preretinal hemorrhage

IRMA = intraretinal microvascular abnormalities; NPDR = nonproliferative diabetic retinopathy

International Clinical Diabetic Macular Edema Disease Severity Scale
Proposed Disease Severity Level Findings Observable upon Dilated Ophthalmoscopy
Diabetic macular edema apparently absent No apparent retinal thickening or hard exudates in posterior pole
Diabetic macular edema apparently present Some apparent retinal thickening or hard exudates in posterior pole
If diabetic macular edema is present, it can be categorized as follows:
Proposed Disease Severity Level Findings Observable upon Dilated Ophthalmoscopy*
Diabetic macular edema present Mild diabetic macular edema: Some retinal thickening or hard exudates in posterior pole but distant from the center of the macula
Moderate diabetic macular edema: Retinal thickening or hard exudates approaching the center of the macula but not involving the center
Severe diabetic macular edema: Retinal thickening or hard exudates involving the center of the macula

* Hard exudates are a sign of current or previous macular edema. Diabetic macular edema is defined as retinal thickening; this requires a three-dimensional assessment that is best performed by dilated examination using slit-lamp biomicroscopy and/or stereo fundus photography.

 

References:

  1. Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT; Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003 Sep;110(9):1677-82. [Medline]
  2. Ciulla TA, Amador AG, Zinman B. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies. Diabetes Care. 2003 Sep;26(9):2653-64. [Medline]

 

Created: Sep 12, 2006

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