Diabetic retinopathy classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan Bir Singh, M.B.B.S.[2] Afsaneh Morteza, MD-MPH [3]

Classification

Modified Airlie House Classification

In 1968 experts met in Airlie House, Virginia to develop a standarized classification of DR. This classification was modified and used in the Diabetic Retinopathy Study (DRS). It consisted of comparing stereophotographs in 7 standard photographic fields with the patient’s findings in those same 7 photographic fields.

This same classification was modified for use in the Early Treatment of Diabetic Retinopathy Study (ETDRS). It became the gold standard for many years. The modified Airlie House Classification of DR is based on grading of stereophotographs of 7 fields and classifies DR into 13 complex levels ranging from level 10 (absence of retinopathy) to level 85 (severe vitreous hemorrhage or retinal detachment involving the macula). It is an excellent tool in the research setting but its clinical applicability is limited due to its complexity. Most ophthalmologists do not use this classification in their daily clinical work.

International Clinical Disease Severity Scale

This disease severity scale is based upon the findings of the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) and the ETDRS. There are five stages that are recognized as per the scale. The first is “no apparent retinopathy”. As the name implies there are no diabetic fundus changes. The second stage is “mild non-proliferative retinopathy” (NPDR). This stage is characterized by the presence of a few microaneurysms. The third stage is “moderate NPDR” which is characterized by the presence of microaneurysms, intraretinal hemorrhages or venous beading. “Severe NPDR”, the fourth stage, is the key level to identify.

The disease is classified according to types of lesions detected on fundoscopy into non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Diabetic retinopathy affect both eyes in parallel. NPDR is subdivided into mild and moderate-to-severe forms.

Mild NPDR

1. Microaneurysms
2. Dot and blot hemorrhages
3. Hard (intra-retinal) exudate

Moderate-to-severe NPDR

Is mild NPDR plus:

1. Cotton-wool spots
2. Venous beading and loops
3. Intraretinal microvascular abnormalities ( IRMA )

PDR

1. Neovascularization of the retina, optic disc or iris
2. Fibrous tissue adherent to vitreous face of retina
3. Retinal detachment
4. Vitreous hemorrhage
5. Pre-retinal hemorrhage

Some people develop a condition called macular edema. It occurs when the damaged blood vessels leak fluid and lipids onto the macula. The fluid makes the macula swell, which blurs vision.