Diabetic Retinopathy

Retinopathy Grade Retinal abnormality Action needed Image

Normal

Peripheral retina
Background (R1) Dot haemorrhages Annual screening
• capillary aneurysms
• Appear first
Blot harmorrhages
• Leakage of blood into deep layers
Hard exudates
• Exudation of plasma rich in lipids
and protein
• Yellow/white with defined margin
Cotton wool spots
• Greyish/white, not defined
 Diabetic Retinopathy

Pre-proliferative (R2) Venous loops Non-urgent referral

Intraretinal microvascular abnormalities to an
• IRMAs ophthalmologist
Multiple deep, round haemorrhages
 Diabetic Retinopathy

Proliferative (R3) New blood-vessel formation Urgent referral to an

Preretinal or subhyaloid haemorrhage ophthalmologist
Vitreous haemorrhage
 Diabetic Retinopathy

Advanced Retinopathy Urgent referral to an

ophthalmologist –
but much vision
already lost

Retinal fibrosis
Traction retinal detachment
Central retina
Maculopathy Hard exudates within 1 disc-width of Prompt referral to an
macula ophthalmologist
Lines or circles of hard exudates within 2
disc-widths of macula
Microaneurysms or retinal haemorrhages
within 1 disc-width of macula if associated
with an unexplained visual acuity 6/12 or
worse