ETDRS_Diabetic_Retinopathy_SeverityRating_MacEdema v.0
The ETDRS Diabetic Retinopathy Severity Scale is composed of 5 scales with increasing risk of retinopathy. It is used to classify diabetic retinopathy for treatment and prognostication. Level 0 is no apparent retinopathy which means there are no abnormalities found. Level 1 is Mild Non-proliferative Diabetic Retinopathy and patient presents with micro-aneurysms only. Level 2 is Moderate Non-proliferative Diabetic Retinopathy is defined as more than just micro-aneurysms but less than severe non-proliferative diabetic retinopathy. Level 3 is Severe Non-proliferative Diabetic Retinopathy has any of the following: more than 20 intra-retinal hemorrhages in each of 4 quadrants; definite venous beading in more than or equal to 2 quadrants; prominent intra-retinal microvascular abnormalities in more than or equal to 1 quadrant; or no signs of proliferative retinopathy. Level 4 is Proliferative Diabetic Retinopathy which is described as having one or more of the following: neovascularization and/or vitreous hemorrhage or pre-retinal hemorrhages. Macular edema severity rating has 2 levels: level 0 as No Macular Edema and level 1 as Macular Edema. Macular Edema has the presence of exudates or apparent thickening within 1 disc diameter from fovea and these are absent in level 0 [1].
The ETDRS (Early Treatment Diabetic Retinopathy Study) Severity Scale was developed for improved coordination among physicians who treats diabetic patients, as it aims to standardize the classification for appropriate treatment and follow-up [2]. As the number of diabetic patients continues to increase, the cases of diabetic retinopathy will also increase. It will necessitate early screening, accurate diagnosis, and evidence-based treatment of diabetic retinopathy to combat this blinding condition. The Macular Edema Severity Scale is used for diagnosis, treatment, and prognostication of macular edema as it is the most common complication of diabetic retinopathy and the most common cause of visual loss in these patients [3].
The Diabetic Retinopathy Severity Scale is for use solely for diabetic retinopathy and not applicable to other retinal diseases. Macular edema severity scale is used to classify patients with macular edema due to diabetic retinopathy only and not due to other retinal diseases. Appropriate use involves the expertise of an ophthalmologist as an eye exam is necessary to see the retinal findings. However, it can also be used in educational and training purposes, especially of students and ophthalmic staff.
Misuse may occur if the scale is used to classify eye diseases other than diabetic retinopathy and macular edema due to diabetic retinopathy. Misuse can also occur if the scale is used by non-experts on the field.
1. Wilkinson CP, Ferris FL, Klein RE, Lee PP, Agardh CD, Davis M, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema severity scales. Ophthalmology 2003; (110) 9:1677-1682. 2. Solomon SD, Goldberg MF. ETDRS Grading of Diabetic Retinopathy: Still the Gold Standard? Ophthalmic Res 2019; 62:190-195. 3. Mitchell P, Wong TY. Management Paradigms for Diabetic Macular Edema. Am J Ophthalmol 2014; (157) 3:505-513.
openEHR-EHR-EVALUATION.problem_diagnosis, openEHR-EHR-EVALUATION.etdrs, openEHR-EHR-CLUSTER.diabetic_retinopathy_classification
