Last year, we published an article looking at the current approach to screening diabetic retinas in the UK (Optician 27.10.2017) and two further articles explaining the grading system operated. These can be accessed via the following links:
It is recommended you refresh your understanding of the grading principles and management options outlined in these articles before attempting the exercise.
This exercise, the second of two to appear in the coming months, presents you with the retinal images from six patients (disc and fovea centred images for each case) and brief case notes. You are required to look for the retinal lesions present in both images and decide on the appropriate grade according to the English National Diabetic Eye Screening Grading Programme.
Exercise
For each case you must answer the two questions. After reviewing the brief case notes and examining the disc and macula centred image:
1. How would you grade this retina?
- R0 M0
- R1 M0
- R1 M1
- R2 M0
- R2 M1
- R3A M0
- R3A M1
2. How would you manage the final outcome?
- Annual Recall
- Routine Referral *
- Urgent Referral **
- Emergency Referral ***
Question two is based upon the following definitions for referral and so local variation in timescale is not reflected.
- Routine Referral – refer within 3 weeks and seen in HES within 13 weeks of screening event
- Urgent Referral – refer within 2 weeks and seen in HES within 6 weeks of screening event
- Emergency Referral – immediate referral and seen in HES within 24 hours