In the Keith-Wagener-Barker classification of hypertensive retinopathy, which finding characterizes Grade IV disease?
- A Papilledema superimposed on Grade III changes ✓
- B Cotton wool spots and flame-shaped hemorrhages
- C Arteriovenous nipping with narrowing of arterioles
- D Focal arteriolar constriction without hemorrhages
Correct answer: A. Papilledema superimposed on Grade III changes
Explanation
Grade IV hypertensive retinopathy is defined by optic disc swelling (papilledema) occurring on a background of severe retinopathy with hemorrhages, exudates and cotton wool spots. Grade III shows the same retinal changes but with a normal disc, making it the key distractor. Grade I features generalized arteriolar narrowing and Grade II adds arteriovenous nipping, both lacking hemorrhagic or exudative signs. Malignant hypertension classically produces Grade IV changes.
Reference: Parsons' Diseases of the Eye, 23rd ed.
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