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Retinopathy and Maculopathy Screening

Marryat Stevens
Updated

Please review and grade each eye separately for:

  1. Retinopathy (R0-R6)
  2. Maculopathy (M0-M2)

and record the highest level of finding applicable and any coincidental findings.

Retinopathy GradeDescription
R0No Diabetic Retinopathy anywhere
R1 (mild)

Background Diabetic Retinopathy (BDR) - Mild

Presence of at least one of the following features anywhere.

  • Dot haemorrhages
  • Microaneurysms
  • Hard exudates
  • Cotton wool spots
  • Blot haemorrhages
  • Superficial/ flame shaped haemorrhages
R2 (observable background)Background Diabetic Retinopathy (BDR) - Observable
Four or more blot haemorrhages in one hemi-field only 
*(Inferior and superior hemi-fields – see below) 
R3 (referable background)
 

Background Diabetic Retinopathy (BDR) – Referable

Any of the following features:

  • Four or more blot haemorrhages (i.e. 2AH standard photograph 2a – see below) in both inferior and superior hemi-fields
  • Venous beading (2AH standard photograph 6a – see below)
  • IRMA (2AH standard photograph 8a – see below)
R4 (profilerative)

Proliferative Diabetic Retinopathy (PDR)

Any of the following features:

  • Active new vessels
  • Vitreous haemorrhage
R6 (Inadequate)

Not adequately visualised

  • Technical failure
  • Retina not sufficiently visible for assessment
Maculopathy GradeDescription
M0 (No Maculopathy)

No Maculopathy

No features within 2 disc diameters from the centre of the fovea sufficient to qualify for M1 or M2 as defined below

M1 (observable)

Observable Maculopathy

Lesion as specified within a radius of > 1 but < 2 disc diameters of the centre of the fovea

  • Any hard exudates
M2 (referable)

Referable Maculopathy

Lesions as specified below within a radius of <1 disc diameter of the centre of the fovea

  • Any hard exudates

 

Coincidental FindingsDescription
Photo-coagulationLaser photocoagulation scars present
Other

Other non-diabetic lesion present:

  • Pigmented lesion (naevus)
  • Age-related macular degeneration
  • Drusen maculopathy
  • Myelinated nerve fibres
  • Asteroid hyalosis
  • Retinal vein thrombosis
     

 

x = 1 disc diameter

Superior and inferior hemifield delineated by a line passing through the centre of the fovea and optic disc)

Image quality definition

1. An image with visible referable retinopathy or maculopathy is always an adequate
image for the purposes of grading.
2. An image that has adequate quality for grading has both adequate field definition
(“has the correct area of retina been photographed?”) and adequate
clarity (“would referable retinopathy and maculopathy be identified, if present).
2.1 An image with adequate field definition displays the intended macula-
centred 45°portion of the retina
2.1.1. The entire optic disc must be displayed
2.1.2. The fovea must be at least 2.0 DD (disc diameters) from the edge of the image.
 

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