The Diabetic Retinopathy Study (DRS) defined 'high-risk characteristics' (HRC) for proliferative diabetic retinopathy. Which combination CORRECTLY represents HRC?
- A New vessels on or within 1 DD of disc (NVD) ≥ 1/4 to 1/3 disc area, OR any NVD with vitreous haemorrhage, OR NVE ≥ 1/2 disc area with vitreous haemorrhage ✓
- B NVD of any size with hard exudates, OR cotton wool spots, OR venous beading
- C NVE in all 4 quadrants without haemorrhage
- D IRMA in 2 or more quadrants with microaneurysms
Correct answer: A. New vessels on or within 1 DD of disc (NVD) ≥ 1/4 to 1/3 disc area, OR any NVD with vitreous haemorrhage, OR NVE ≥ 1/2 disc area with vitreous haemorrhage
Explanation
The DRS defined high-risk PDR as: NVD ≥ 1/4–1/3 disc area, any NVD + vitreous or preretinal haemorrhage, or NVE ≥ 1/2 disc area + vitreous or preretinal haemorrhage. These features carry a >50% risk of severe visual loss within 2 years without treatment. The presence of ANY haemorrhage with new vessels dramatically worsens prognosis. Options B, C, and D describe NPDR features, not high-risk PDR.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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