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:
- 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]
- 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
