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International Clinical Diabetic Retinopathy and Diabetic Macular Edema Disease Severity Scales

International Clinical Diabetic Retinopathy Disease Severity Scale

Proposed Disease Severity Level

Findings Observable upon Dilated Ophthalmoscopy

No apparent retinopathy

No abnormalities

Mild nonproliferative diabetic retinopathy

Microaneurysms only

Moderate nonproliferative diabetic retinopathy

More than just microaneurysms but less than severe NPDR

Severe nonproliferative diabetic retinopathy

Any of the following:

More than 20 intraretinal hemorrhages in each of four quadrants

Definite venous beading in two or more quadrants

Prominent IRMA in one or more quadrants

And no signs of proliferative retinopathy

Proliferative diabetic retinopathy

One or both of the following:

Neovascularization

Vitreous/preretinal hemorrhage

IRMA = intraretinal microvascular abnormalities; NPDR = nonproliferative diabetic retinopathy

 

International Clinical Diabetic Macular Edema Disease Severity Scale

Proposed Disease Severity Level

Findings Observable upon Dilated Ophthalmoscopy

Diabetic macular edema apparently absent

Diabetic macular edema apparently present

No apparent retinal thickening or hard exudates in posterior pole

Some apparent retinal thickening or hard exudates in posterior pole

If diabetic macular edema is present, it can be categorized as follows:

Proposed Disease Severity Level

Findings Observable upon Dilated Ophthalmoscopy*

Diabetic macular edema present .

Mild diabetic macular edema: Some retinal thickening or hard exudates in posterior pole but distant from the center of the macula

Moderate diabetic macular edema: Retinal thickening or hard exudates approaching the center of the macula but not involving the center

Severe diabetic macular edema: Retinal thickening or hard exudates involving the center of the macula . .

* Hard exudates are a sign of current or previous macular edema. Diabetic macular edema is defined as retinal thickening; this requires a three-dimensional assessment that is best performed by dilated examination using slit-lamp biomicroscopy and/or stereo fundus photography.

Related Criteria

Criteria for the Diagnosis of Diabetes Mellitus

More...

References: 

  1. Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT; Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003 Sep;110(9):1677-82. [Medline]

  2. Ciulla TA, Amador AG, Zinman B. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies. Diabetes Care. 2003 Sep;26(9):2653-64. [Medline]

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Created: September 12, 2006
Last Modified: 10/17/2010

 
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