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Dr screening training for nurses interpretation of retinal images for dr screening
1. 1
Interpretation of retinal images for DR screening
Step one
Check the quality of the photos.
Adjust for suitable brightness and contrast of the computer screen.
Step two
Carefully screen throughout the retina.
Step three
If there are no pathological lesions of retina
Diagnosis: no DR. R0. Annual screening
Step four
If there are MA/dot-blot hemorrhages
Diagnosis: mild NPDR. R1. Annual screening
If the number of MA/dot-blot hemorrhage in each quadrant is > 20 points.
Diagnosis: severe NPDR. R2. Urgent refer
If there is at least one lesion of HE, CWS, FSH
Diagnosis: moderate NPDR. R2. Refer
Then look for the appearance of the "4-2-1 rule".
o Count the number of MA if there are more than 20 points in each
quadrant or not.
o Look for venous beading.
o Look for IRMA.
If none of the "4-2-1 rule" present
Keep looking for the characteristic of PDR such as NVD, NVE, preretinal
hemorrhage, vitreous hemorrhage, fibrous proliferation
If findings are compatible with the "4-2-1 rule" and ensured that it is not the
PDR
Diagnosis: severe NPDR. R2. Urgent refer
If there is no PDR characteristic
Diagnosis: moderate NPDR. R2. Refer
If any character of PDR present
Diagnosis: PDR. R3. Urgent refer
Step five
If there are no pathological lesions of macula
Diagnosis: no Maculopathy. M0. Annual screening
2. 2
Step Six
If there is any of the following:
Exudate < or = 1DD of center of fovea
Circinate or group of exudates within macula
Microaneurysm or hemorrhage < or = 1DD of center of fovea
Retinal thickening < or = 1DD of center of fovea
Diagnosis: Diabetic Maculopathy. M1. Refer
Step Seven
If there is any of the following:
Other lesion
Ungradable image
Diagnosis: Other lesion. OL. Refer for Assessment
Diagnosis: Un-gradable. UG. Refer for Assessment