Diabetic Retinopathy Grading

Question 1

grading the diabetic retinopathy with the quadrants. To separate the quads on the retina

Answer 1

make 4 quadrants on the retina at the optic nerve. Label each quad on a sheet of paper. ST, SN, IT, IN

Question 2

start with the hemorrhages …. aka 2a. What is 2a?

Answer 2

this pic of retina. has hemorrhages in it. they are the red spots. there are 76 spots in this photo. burn this photo in brain. and ask is it more 76 red spots or less than 76 spots? or memorize what this pic looks like.

there are also microaneurysums.

Question 3

what is 6a and 6b?

Answer 3

on the the 4 quadrants grade , grade the venous beading.

6a=broken light reflex with some fat areas

6b=blood vessels look like sausage links

the question to ask myself during the exam is …do i have this level of beading .

REMEMBER TAKE EACH QUAD FOR ITS OWN/.

Question 4

Memorize this pic. What am i comparing?

Answer 4

the light reflex of this image to whatever is given to me on the test

Question 5

memorize this pic. what am i comparing?

B.

Answer 5

the venous beading.

do i have this level of venous beading in my quad that I am looking at . Does it look like a snake swallowing a golf ball?

Question 6

memorize this pic. what am i comparing?

Answer 6

8a. the IRMA

do I have at least three IRMA in my quad.

does it like a red thread that has fallen in between major blood vessels.

I need to see at least three threads. For it to be greater 8a.

If I see a IRMA present (on the labeling for 8a )but its not three or more its <8a

While

If I see IRMA definitely present, its counts as moderate.

Question 7

what are the different types of grades for retinopathy?

Answer 7

mild

moderate

severe

Question 8

what counts as a mild grade retinopathy?

Answer 8

one microaneurysum in the retina/any of the four quaduarants

<2a

Question 9

Name the grade of diabetic retinopathy : mild, moderate, or severe

• chracterized by at LEAST one microanerysum.
• the severity is less than 2a’s hemorrhages/microaneyrsums.

Answer 9

mild ______ retinopathy. (non-profilerative)

Question 10

Name the grade of diabetic retinopathy : mild, moderate, or severe

-there is Hemorrhages/microaneurysums greater than 2a in ONE OR THREE QUADRANTS

and/or

-soft exudates, venous beading, or IRMA definitely present

Answer 10

moderate _________ diabetic retinopathy (non profillerative)

Question 11

Name the grade of diabetic retinopathy : mild, moderate, or severe

-is greater than 2a in all four quads,

OR Venous beading (6b) in two quads

OR IRMA greater than 8a in at least one quad

Answer 11

SEVERE______ DIABETIC RETINOPATHY (non-profilerative)

Question 12

what are soft exudates?

Answer 12

cotton wool spots.

cotton wool spots present is going to make it moderate.

Question 13

once a patient reaches profilerative retinopathy, they are always profilerative retinopathy.

Answer 13

true

Question 14

the 4th stage of diabetic retinopathy is

Answer 14

profileration.

you can have early proliferative diabetic retinopathy (PDR)

or High risk PDR

Question 15

what are the stages of diabetic retinopathy development?

Answer 15

mild non-profilerative diabetic retinopathy

moderate non-profilerative diabetic retinopathy

severe non-profilerative diabetic retinopathy

early profilerative diabetic retinopathy

high risk profilerative diabetic retinopathy

Question 16

early profilerative diabetic retinopathy (PDR)

Answer 16

-New vessels (blood) at the disk (NVD)

or

-New vessels elsewhere (NVE)

less than standard 10a photo

or

Preretinal Hemorrhage(boat hemorrhage) <1/2 DA without NVD

Question 17

If I see profilerative diabetic retinopathy, what am I going to do?

Answer 17

Management: I am refering to retinal specialist

Question 18

if somone has pre-retinal hemorrhage…

Answer 18

send to retinal specialists

Question 19

somebody has more than a quater of the disk of neovascularization

Answer 19

send them out

Question 20

the reason we care about grading diabetic retinopathy? what are we essentially doing

Answer 20

we are assessing their risk of developing to the last stage of

HIGH Risk Profilerative Diabetic Retinopathy.

These patients suffer from severe vision loss or blindness.

Question 21

As the staging of diabetic retinopathy goes up what happens to the one risk of High Risk PDR

Answer 21

it also increases

Question 22

the patients who have a stage of severe NPDR is ____ at one year and ___ at five year risk of developing high risk profilerative retinopathy

Answer 22

52%

60-75%

Question 23

Management of patient

with diabetes and no apparent diabetic retinopathy

Answer 23

optimize medical therapy of glucose, blood pressure, and lipids

Question 24

Management of patient

mild non-profilerative diabetic retinopathy

Answer 24

an annual eye exam for monitoring

Question 25

Management of patient

mild non-profilerative diabetic retinopathy with one or more of the following

DME, coincedent medical risk factors such as HTN, renal disease, or pregnancy (these predispose pt to progression)

Answer 25

RTC in 3-4 months for monitoring

Question 26

Management of patient

mild non-profilerative diabetic retinopathy with CME

Answer 26

-RTC in 1-3 months for monitoring

Question 27

Management of patient

moderate non-profilerative diabetic retinopathy without DME or any other risk factors

Answer 27

-RTC in 6-9 months for diabetic retinopathy monitoring

Question 28

Management of patient

moderate non-profilerative diabetic retinopathy

WITH

DME

Answer 28

-RTC in 4 to 6 months for monitoring

Question 29

Management of patient

moderate non-profilerative diabetic retinopathy

WITH

CSME

Answer 29

-RTC IN 1-3 months for monitoring of diabetic retinopathy

Question 30

Management of severe or very severe NPDR.

Answer 30

-RTC IN 1-3 months in consulatation with a retinal specialist.

“in consulation” means giving an opinion on the management

-99/100 the retinal specialist is going to say bring them.

IF CME is present, they need the anti-vegf shot.

Question 31

management of profilerative or high risk pdr

Answer 31

-send out to retinal specialists.

Question 32

After staging/grading the diabetic retinopthy, I need to one more thing

Answer 32

Edema!

Question 33

CSME (clinically significant macular edema) :

what are the three ways

Answer 33

1. any retinal edema within 500 microns of the fovea (I can look for the foveal avascular zone thats the smaller circle)
2. Hard exudates in the foveal avascular zone (within 500 microns) with adjacent retinal thickening

3. retinal edema that is greater than 1 disc areain size AND within 1 disc diameter of the center of the fovea.

Question 34

Abnormally thick on an OCT is over _____ microns in the fovea.

Answer 34

300 microns

Question 35

Abnormally thick on an OCT is over _____ microns in the second ring

Answer 35

anything over 320.

Question 36

In addition to the 2a, 6b, and 8a

(Is it greater than or equal to 2a? Yes or no

is it greater than or equal to 6b? Yes or no

is it greater than or equal to 8a (with the three IRMAs)? Yes or no)

what things in a photo count as moderate?

Answer 36

Cotton wool spots (easy to miss these)

Venous beading

IRMA

Question 37

If i see venous beading, I know its already on moderate spectrum but the question is …

Question 38

If I see IRMA present, I know its moderate. But the question is….

Question 39

For diabetic retinopathy to be labeled as severe I follow the

________ rule