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Home E-learning Chapter 5: The severity of diabetic retinopathy.

Chapter 5: The severity of diabetic retinopathy.

The level of diabetic retinopathy can be divided into 5 different levels based on the International
Clinical Classification

1. No DR

There is no diabetes retinopathy. We do not find any pathological lesions of DR in the retina.

2.Mild non-proliferative diabetic retinopathy (NPDR)

The mild degree of diabetic retinopathy. An abnormality found in this level is only
microaneurysms/dot-blot hemorrhage.

3.Moderate NPDR

The moderate degree of diabetic retinopathyAbnormalies found in this level are

- Hard exudates (HE)

- Flame shape hemorrhage (FSH)

- Cotton wool spot (CWS)

With only one of an above present, the diagnosis of moderate NPDR can be made.

4. Severe NPDR

The high degree of diabetic retinopathy. The diagnosis can be made with one of the following 3

1) more than 20 microaneurysms/dot-blot hemorrhages scattered in each quadrant of the


2) The venous beading in at least 2 quadrants.

            3) IRMA in any area.

Note: Remember "Rule 4-2-1": 4 quadrants of the MA/dot-blot hemorrhages, 2 quadrants of venous
beading, and1 quadrant of IRMA. Anyone of these found, we can make a diagnosis of severe NPDR.

5. PDR (proliferative diabetic retinopathy)

        A level of diabetic retinopathy that have newly regenerated blood vessels (both NVD and NVE).  The NV may
cause preretinal hemorrhage
, vitreous hemorrhage, and fibrous proliferation


There are 3 dots of MA/dot-blot hemorrhage, no other pathologic findings of DR.




1. Which one is not the characteristic of severe NPDR?

a. Microaneurysms/dot-blot hemorrhage more than 20 points scattered in each of the 4 quadrants of the retina.
b. Venous beadings in at least 2 quadrants
d. NVD
e. None of the above

2. Which one is not the characteristic of moderate NPDR?

a. Hard exudates (HE)
b. Flame-shaped hemorrhage (FSH)
c. Cotton wool spots (CWS)
d. Venous beading in any quadrants of the retina
e. Drusen

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