A 35-year-old with type 1 diabetes mellitus presents for routine ophthalmology review. He has no visual complaints. Fundoscopy shows dot-blot haemorrhages, microaneurysms in all quadrants, and 2 areas of IRMA (intraretinal microvascular abnormalities), but no disc neovascularisation. How should he be classified and when should he next be reviewed?
- A Moderate NPDR; review in 6 months ✓
- B Mild NPDR; review annually
- C Severe NPDR (4-2-1 rule); review in 3 months or consider PRP
- D PDR (proliferative diabetic retinopathy); urgent PRP
Correct answer: A. Moderate NPDR; review in 6 months
Explanation
The ETDRS severity scale classifies NPDR as: mild (microaneurysms only), moderate (more than mild but not qualifying for severe), and severe (4-2-1 rule: haemorrhages in all 4 quadrants OR venous beading in ≥ 2 quadrants OR IRMA in ≥ 1 quadrant). Dot-blot haemorrhages in all 4 quadrants without NV might suggest severe, but IRMA in fewer than 1 quadrant with MA and haemorrhages is moderate NPDR. Moderate NPDR requires 6-monthly review; severe NPDR (meeting 4-2-1) warrants 3-monthly review and consideration of PRP.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.