Table 2.

Content from IHS-JVN Grading Report, Two Example Patients

IHS-JVN REPORT DOMAINS	EXAMPLE PATIENT 1	EXAMPLE PATIENT 2
Background
Includes: name, gender, date of birth, age, Imager name, referring physician and contact, date location, etc.	Not shown here.	Not shown here.
Medical risk factors for DR
Duration of diabetes	22 years	1 year
Last eye exam	Date not shown here—calculated as 2 years ago	Date not shown here—calculated as 2 years ago
Lab studies:
A1c	11.3%	12.7%
LDL	150 mg/dL	400 mg/dL
HDL	57 mg/dL	19 mg/dL
Total cholesterol	238 mg/dL	298 mg/dL
Blood pressure	120/88 mm Hg	143/89 mm Hg
Imaging results
Level of NPDR	Right eye: moderate; left eye: moderate	Right eye: unable to grade; left eye: unable to grade
Level of PDR	Right eye: no evidence; left eye: no evidence	Right eye: unable to grade; left eye: unable to grade
Level of DME	Right eye: no evidence; left eye: no evidence	Right eye: no evidence; left eye: unable to grade
Additional findings	Right eye: hypertensive retinopathy, central vein occlusion, cotton wool spots; left eye: hypertensive retinopathy, cotton wool spots	Right eye: other; left eye: other
Management plan guidance
Risk level	High	Medium
Summary	This patient's A1c is very high (>10%). Initiation of intensive glycemic control in a gradual manner is recommended to reduce the risk of development and progression of DR. Reducing A1c to <7.0% or as low as medically appropriate to this patient's particular circumstances is recommended over time.	This patient's A1c is very high (>10%). Initiation of intensive glycemic control in a gradual manner is recommended to reduce the risk of development and progression of DR. Reducing A1c to <7.0% or as low as medically appropriate to this patient's particular circumstances is recommended over time.
	DR evident by JVN examination; see Imaging Results. Non-DR pathology evident by JVN exam; see Imaging Results.	Elevated blood pressure (≥130/80) has been shown to increase the risk of development and progression of DR as well as cotton wool spot formation. Optimization of blood pressure control is recommended as medically appropriate to this patient's particular circumstances.
	Refer to eye clinic: based on the earlier findings, we recommend follow-up with an optometrist/ophthalmologist for central retinal vein occlusion within 3 weeks and with PCP for hypertension/diabetes control and cardiovascular work-up.	Dyslipidemia: elevated lipids have been associated with the presence and severity of hard exudates and moderate vision loss in patients with diabetes. Optimization of lipids is recommended as medically appropriate to this patient's particular circumstances.
		Non-DR finding evident by JVN exam; see Imaging Results.
		Refer to eye clinic: based on the earlier findings, we recommend follow-up with an optometrist/ophthalmologist within 3 months for comprehensive eye exam (DR evaluation and lipemia retinalis follow-up). Patient should continue follow-up with his primary care doctor regarding hypertriglyceridemia.

This information was obtained from real IHS-JVN Reading Center reports and reformatted for this table. Background information is not shown to protect patient privacy.

HDL, high-density lipoprotein; LDL, low-density lipoprotein; IHS-JVN, Indian Health Service-Joslin Vision Network; PCP, primary care provider.