In the classification of diabetic retinopathy by the International Clinical Diabetic Retinopathy Disease Severity Scale, the finding that indicates the transition from non-proliferative to proliferative diabetic retinopathy is:

• A Presence of cotton wool spots
• B Venous beading in two or more quadrants (4-2-1 rule changes)
• C New vessels on disc (NVD) or elsewhere (NVE) on the retina ✓
• D Hard exudates within one disc diameter of the fovea

Explanation

Proliferative diabetic retinopathy (PDR) is defined by the presence of neovascularization — new blood vessels arising from the disc (NVD) or elsewhere on the retina (NVE). These vessels are driven by retinal ischemia-induced VEGF upregulation and represent the transition to the proliferative stage. Cotton wool spots, venous beading, and the 4-2-1 rule changes (20 or more intraretinal hemorrhages in 4 quadrants, venous beading in 2 quadrants, or IRMA in 1 quadrant) define severe NPDR — the stage immediately preceding PDR.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.