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Eyes on Diabetes - Discussing Diabetic Retinopathy

Info for Health Professionals

Retinopathy Chart

Prepared by the Diabetic Retinopathy Working Party of the NHMRC in conjunction with the Australian Diabetes Society Retinopathy Sub-Committee.

Material derived from NHMRC "Clinical Practice Guidelines for the Management of Diabetic Retinopathy".

Close up image of an eye showing minimal non-proliferative diabetic retinopathy (npdr).

FIGURE 1. MINIMAL NON-PROLIFERATIVE DIABETIC RETINOPATHY (NPDR) -- FEW SCATTERED MICROANEURYSMS (m) ONLY, THE REMAINDER OF THE FUNDUS IS NORMAL.

Close up image of an eye showing mild non-proliferative diabetic retinopathy.

FIGURE 2. MILD NON-PROLIFERATIVE DIABETIC RETINOPATHY -- MICROANEURYSMS (m) AND DOT HAEMORRHAGES (h). ALSO DEMONSTRATES MACULAR OEDEMA WITH A SMALL AMOUNT OF LIPID EXUDATE (e) -- NOT CLINICALLY SIGNIFICANT.

Close up image of an eye showing moderate non-proliferative diabetic retinopathy.

FIGURES 3. MODERATE NON-PROLIFERATIVE DIABETIC RETINOPATHY -- COTTON WOOL SPOTS (w) RETINAL HAEMORRHAGES (h) AND MICROANEURYSMS (m)

Classification, Clinical Signs and Referral Recommendation

Minimal NPDR (fig 1)

Isolated Microaneurysms only (m).

Referral may not be needed. Review annually with dilated fundus exam.

Mild NPDR (fig 2)

Microaneurysms (m) + retinal haemorrhages (h) Routine referral to an ophthalmologist.

Review with ophthalmologist at least annually.

Moderate NPDR (fig 3)

Haemorrhages and microaneurysms (h,m) in at least 1 quadrant + cotton wool spots (w) or venous beading in 1 quadrant only.

Refer to an ophthalmologist as soon as possible

Severe NPDR (fig 4)

One of the following:

Refer to an ophthalmologist urgently. PRP may be indicated.

PDR (fig 5)

One or more of the following:

Refer to an ophthalmologist urgently. PRP is indicated.

High risk PDR (fig 6)

One or more of the following:

Refer to an opthalmologist urgently. PRP is indicated.

Macular oedema (fig 2)

Retinal oedema or thickening within 2 disc diameters of the macular centre. Refer to an ophthalmologist as soon as possible.

Clinically significant macular oedema (CSME) (fig 9)

Retinal oedema thickening or hard exudates within 50 mm of macular centre (1/3 diameter of optic disc) or, Retinal oedema or thickening one disc diameter or larger in size, any part of which is within a disc diameter of the centre of the macula.

Refer to an ophthalmologist urgently. Macular laser indicated.

Close up image of an eye showing severe non-proliferative diabetic retinopathy.

FIGURE 4. SEVERE NON-PROLIFERATIVE DIABETIC RETINOPATHY -- INTRARETINAL MICROVASCULAR ABNORMALITIES OR IRMA (i) VENOUS READING (b) OR VENOUS CALIBER CHANGES, WIDESPREAD RETINAL ISCHAEMIA AND COTTON WOOL SPOTS (w) -- BEGINNING OF NEW VESSEL ON OPTIC DISC.

Close up image of an eye showing proliferative diabetic retinopathy.

FIGURE 5. PROLIFERATIVE DIABETIC RETINOPATHY -- PERIPHERAL NEW VESSEL (v), RETINAL HAEMORRHAGES (h) AND NO VITREOUS OR PRE-RETINAL HAEMORRHAGE -- NOTE LACK OF OTHER RETINOPATHY FEATURES.

Close up image of an eye showing high-risk proliferative diabetic retinopathy.

FIGURE 6. HIGH-RISK PROLIFERATIVE DIABETIC RETINOPATHY -- LARGE FROND OF DISC NEW VESSEL (v) AND PRE RETINAL HAEMORRHAGE (h).

Close up image of an eye showing high-risk proliferative diabetic retinopathy post treatment.

FIGURE 7. HIGH-RISK PROLIFERATIVE DIABETIC RETINOPATHY POST TREATMENT WITH PAN-RETINAL LASER PHOTOCOAGULATION SCARS (s) TEMPORARILY AND NASALLY -- DISC NEW VESSELS REGRESSED.

Close up image of an eye showing aadvanced proliferative diabetic retinopathy preretinal fibrovascular tissue producing traction on retina across the macular region.

FIGURE 8 ADVANCED PROLIFERATIVE DIABETIC RETINOPATHY PRERETINAL FIBROVASCULAR TISSUE PRODUCING TRACTION ON RETINA (f) ACROSS THE MACULAR REGION.

Close up image of an eye showing clinically significant macular oedema localized area of retinal oedema surrounded by lipid exudates extending to the macula.

FIGURE 9 CLINICALLY SIGNIFICANT MACULAR OEDEMA LOCALIZED AREA OF RETINAL OEDEMA SURROUNDED BY LIPID EXUDATES (E) EXTENDING TO THE MACULA.

Useful Links

Important information can be found on the websites of associated organsiations.

Useful Links for Health Professionals

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What is diabetic retinopathy?

Retinopathy Chart

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Royal Victorian Institute For the Blind - Services Booklet

Vision Australia

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NHMRC Guidelines for Diabetic Retinopathy

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RVEEH Retinopathy Poster

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