Info for Health Professionals
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".
FIGURE 1. MINIMAL NON-PROLIFERATIVE DIABETIC RETINOPATHY (NPDR) -- FEW SCATTERED MICROANEURYSMS (m) ONLY, THE REMAINDER OF THE FUNDUS IS NORMAL.
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.
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:
- Intraretinal microvascular abnormalities (IRMA) (i) in 1 or more quadrants
- Venous beading (b) in 2 or more quantum
- Haemorrhages/microaneurysms (h,m) in all 4 quadrants.
Refer to an ophthalmologist urgently. PRP may be indicated.
PDR (fig 5)
One or more of the following:
- Peripheral new vessels (NVE) (v)
- Disc new vessels (NVD) less than 1/3 of disc diameter
- Vitreous or preretinal haemorrhage with NVE less than ½ disc area.
Refer to an ophthalmologist urgently. PRP is indicated.
High risk PDR (fig 6)
One or more of the following:
- NVD > = 1/3 disc area (v)
- NVD with vitreous or pre-retinal haemorrhage
- NVE > = ½ disc area with vitreous or preretinal haemorrhage.
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.
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.
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.
FIGURE 6. HIGH-RISK PROLIFERATIVE DIABETIC RETINOPATHY -- LARGE FROND OF DISC NEW VESSEL (v) AND PRE RETINAL HAEMORRHAGE (h).
FIGURE 7. HIGH-RISK PROLIFERATIVE DIABETIC RETINOPATHY POST TREATMENT WITH PAN-RETINAL LASER PHOTOCOAGULATION SCARS (s) TEMPORARILY AND NASALLY -- DISC NEW VESSELS REGRESSED.
FIGURE 8 ADVANCED PROLIFERATIVE DIABETIC RETINOPATHY PRERETINAL FIBROVASCULAR TISSUE PRODUCING TRACTION ON RETINA (f) ACROSS THE MACULAR REGION.
FIGURE 9 CLINICALLY SIGNIFICANT MACULAR OEDEMA LOCALIZED AREA OF RETINAL OEDEMA SURROUNDED BY LIPID EXUDATES (E) EXTENDING TO THE MACULA.