Table 1.
Classifications used to grade Diabetic Retinopathy (DR) presence and severity based on the National Health Service Grading Classification System.43 The last column is the American Academy of Ophthalmology’s recommendations for diabetic patient follow-up.44
| Grade | Description | Recommendation |
|---|---|---|
| R0 | NO DIABETIC RETINOPATHY | Re-evaluate in twelve months with either eye care specialist or photographic screening |
| None | ||
| Isolated cotton wools spots (1 or more) in the absence of any microaneurysm or haemorrhage |
||
| R1 | BACKGROUND DR | Refer to eye care provider |
| 1 or more microaneurysm(s) | ||
| 1 or more retinal haemorrhage(s) | ||
| Any exudates caused by DR | ||
| R2 | PRE-PROLIFERATIVE DR | Refer to ophthalmologist promptly |
| Intraretinal microvascular abnormality (IRMA) | ||
| Venous beading | ||
| Venous loop or reduplication | ||
| Multiple deep, round or blot haemorrhages | ||
| R3 | PROLIFERATIVE DR | Refer to ophthalmologist promptly |
| New vessels on the disc (NVD) | ||
| New vessels elsewhere (NVE) | ||
| Pre-retinal or vitreous hemorrhage | ||
| Pre-retinal fibrosis with or without tractional retinal detachment due to DR |
||
| M | MACULOPATHY | Refer to ophthalmologist promptly |
| Exudate within 1 disc diameter (DD) of the center of the fovea | ||
| Circinate or group of exudates within the macula | ||
| Any microaneurysm or haemorrhage within 1 DD of the center of the fovea only if associated with a best visual acuity of 20/40 or worse |
||
| P | PHOTOCOAGULATION | Refer to eye care provider |
| Focal/grid to macula | ||
| Peripheral scatter | ||
| U | UNCLASSIFIABLE/UNGRADABLE | Refer to eye care provider |
| Due to poor photographic location, focus, or contrast |