Diabetic Retinopathy

• Signs
  • Mild:
    • few microaneurysms
  • Moderate:
    • increased number of microaneurysms
    • dot-blot hemorrhages
    • Cotton wool spots
    • hard exudates
  • Severe:
    • “4-2-1 rule” — 4 quadrants of diffuse retinal hemorrhages and microaneurysms,
    • 2 or more quadrants of venous beading
    • 1 or more quadrant of IRMA – intraretinal microvascular anomalies
• Management
  • Control diabetes, lipids, hypertension
  • Give fenofibrate

Hypertensive Retinopathy

• Grade 0: No changes 
• Grade 1: Barely detectable arterial narrowing 
• Grade 2: Obvious arterial narrowing with focal irregularities (Figure 1) 
• Grade 3: Grade 2 plus retinal hemorrhages, exudates, cotton wool spots, or retinal edema (Figure 3) 
• Grade 4: Grade 3 plus papilledema