Level Grading

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Level ½ Grading

• Margaret Bruce
• John Olson

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Whats it all about?
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Microvascular disease
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Where?
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Not Down Under
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Earlier Features of Capillary Occlusion

• Microaneurysm formation

• Haemorrhage (dots and blots)

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Later Features of Capillary Occlusion

• Intra-retinal microvascular formation

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Late Features of Capillary Occlusion

• Venous beading

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New Vessel Formation
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What are the odds?
"Severe retinal haemorrhages" 4 blot
haemorrhages in 1 quadrant equivalent
2A

• "Venous beading"
• This is a specific appearance.
• Do not include
• Diffuse increase in calibre
• changes within 1/2 DD from disc.
• loops in venous branches calibre of major vein
  at disc margin
• focal narrowing.

6A
IRMA 4 patches in 1 quad) "Narrow, tortuous
intraretinal vascular segments (representing
dilated capillaries and/or intraretinal new
vessels)"
8A
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What are the odds?
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Cotton Wool Spots

• Macrovascular complication
• Arteriolar occlusion
• Superficial nerve fibre layer damage
• Early worsening of diabetic retinopathy
• Severe hypoglycaemia
• Hypertension

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Putting it all together
Yearly Development of High Risk PDR
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Whatever..
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Bleeding
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Pulling
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Oedema
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3 causes of leakage
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What are the odds?

• Exudates?
• Blot haemorrhage?
• Microaneurysm?

• High sensitivity
• Low specificity

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Coffee anyone?
Good
Adequate
Inadequate
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Practice makes perfect..