Diabetic retinopathy-screening training program for nurses St John Eye Hospital - UNRWA

1. Dr. Riyad Banayot
St. John of Jerusalem Eye Hospital
Diabetic Retinopathy Screening
UNIT 8:
GRADING TRAINING PHOTOGRAPHS

2. MICROANEURYSM

3. MICROANEURYSMS AND HEMORRHAGES

4. DOT AND BLOT HEMORRHAGES WITH HARD
EXUDATES

5. SCATTER PHOTOCOAGULATION SCARS IN AN
EYE WITH ACTIVE PDR

6. MACULAR EXUDATES AT FOVEAL EDGE

7. NVD’S

8. MICROANEURYSMS AND INTRARETINAL
HEMORRHAGES

9. VENOUS BEADING

10. CSME WITH HE IN THE FOVEA. CWS ARE PRESENT NEAR
THE MAJOR RETINAL VESSELS

11. FIBROVASCULAR PROLIFERATION OVER THE OPTIC DISC (WHITE
ARROW). LOOPS OF NEW VESSELS ARE ESPECIALLY PROMINENT
SUPERIOR TO THE DISC AND EXTENDING INTO THE MACULA. RING OF
HARD EXUDATE AROUND NEOVASCULAR NET (BLACK ARROW)

12. PRE-RETINAL HEMORRHAGE: BLOOD TRAPPED BETWEEN THE RETINA
AND THE VITREOUS

13. LEFT: MODERATE VITREOUS HEMORRHAGE. RIGHT: AFTER
CLEARING OF THE HEMORRHAGE

14. DENSE VITREOUS HEMORRHAGE ALMOST COMPLETELY
OBSCURING THE VIEW OF THE FUNDUS

15. MARKED FIBROSIS WITH TRACTION EXERTED ON THE
RETINA OUTSIDE THE CENTRAL MACULA (ARROWS)

16. TRACTION RETINAL DETACHMENT OUTSIDE THE MACULA. NOTE
ELEVATION OF RETINAL VESSEL OUT OF THE PLANE OF FOCUS (WHITE
ARROW). SCATTER PHOTOCOAGULATION SCARS ARE SEEN
PERIPHERALLY (BLACK ARROW)

17. FOCAL LASER SCARS IN THE MACULA FOLLOWING
TREATMENT FOR MACULAR EDEMA (ARROW). EDEMA HAS
RESOLVED

18. LASER SCARS SUPERIOR TO THE MACULA IN THE SAME EYE. SPOTS
ARE APPROXIMATELY ONE-HALF BURN WIDTH APART. IN THE TREATED
AREA, THE RETINAL VESSELS ARE SCLEROTIC (ARROWS)

19. NONPROLIFERATIVE
DIABETIC
RETINOPATHY:
INCLUDING DOT-
BLOT
HEMORRHAGES (DB),
FLAME-SHAPED
HEMORRHAGES (F),
HARD EXUDATES
(HE), MICRO-
ANEURYSMS (MA)
AND VENOUS
BEADING (VB)

20. NEW VESSELS ON THE OPTIC DISC

21. DISC NEW VESSELS

22. SEVERAL DOT AND BLOT HEMORRHAGES WITH
HARD EXUDATES

23. NUMEROUS FINE FRAGILE VESSELS

24. LASER SCARS FROM PRP

25. SEVERE TRACTION RETINAL DETACHMENT

26. NEW VESSEL GROWTH ALONG INFERIOR
TEMPORAL VEIN

27. BACKGROUND DIABETIC RETINOPATHY
MICROANEURYSMS, "DOT" AND "BLOT" HEMORRHAGES, "HARD
EXUDATES"

28. PREPROLIFERATIVE DIABETIC RETINOPATHY COTTON WOOL SPOTS
(CWS) INDICATING RETINAL ISCHEMIA,

29. NON-PROLIFERATIVE DIABETIC RETINOPATHY WITH MACULAR EDEMA:
EXUDATE (YELLOW ARROW), MICROANEURYSMS (RED ARROW),
THICKENED RETINA (WHITE CIRCLE), CYSTIC CHANGE AT MACULA
(BLUE ARROW)

30. NORMAL RETINA: THE MACULA IS THE DARK SPOT IN THE CENTER OF
THE PICTURE. THE YELLOW CIRCLE IS THE OPTIC NERVE. THE RETINA
IS ONE OF THE FEW TISSUES IN THE BODY WHERE WE CAN VIEW
BLOOD VESSELS DIRECTLY.

31. NON-PROLIFERATIVE DIABETIC RETINOPATHY: CHARACTERIZED BY
DILATED CAPILLARIES (MICROANEURYSMS) WHICH LEAK RED BLOOD
CELLS AND PLASMA INTO THE SUBSTANCE OF THE RETINA. THIS
RESULTS IN THE APPEARANCE OF RETINAL HEMORRHAGES, EDEMA
(SWELLING), AND DEPOSITS (EXUDATES).

32. MACULAR EDEMA, WITH YELLOW EXUDATES

33. BLEEDING FROM NEOVASCULARIZATION ON THE OPTIC NERVE.
NOTE THE FINE NETWORK OF NEW BLOOD VESSELS ON THE
SURFACE OF THE OPTIC NERVE (YELLOW CIRCLE) WITH A SMALL
HEMORRHAGE (RED BLOOD).

34. VITREOUS HEMORRHAGE FROM NEOVASCULARIZATION OF THE
OPTIC NERVE. A DENSE VITREOUS HEMORRHAGE HAS CAUSED
SEVERE LOSS OF VISION. NOTE THAT IT’S NOW VERY DIFFICULT TO
SEE THE RETINA CLEARLY.

35. HAEMORRHAGES (LARGER, UNEVEN RED 'BLOTS') AND
MICROANEURYSMS (SMALL, ROUND 'DOTS')

36. VITREOUS HEMORRHAGE

37. PROLIFERATIVE DIABETIC RETINOPATHY SHOWING SEVERE ISCHEMIA
(EXTENSIVE MULTIPLE COTTON WOOL SPOTS) AND NEW VESSELS IN
THE SUPEROTEMPORAL ARCADE.

38. SUBHYALOID HAEMORRHAGE (NOTE THE FLUID
LEVEL)

39. MICROANEURYSMS

40. DOT, BLOT, FLAME SHAPED

41. HARD EXUDATES

42. HARD EXUDATES

43. HARD EXUDATES

44. CWS

45. VENOUS ABNORMALITIES

46. IRMA

47. NVE

48. CONNECTIVE TISSUE AND FIBROSIS (GLIOSIS)

49. RD

50. VH

51. VH

52. SUB-HYALOID HEMORRHAGE

53. PREPROLIFERATIVE RETINOPATHY: CONSIST OF MULTIPLE COTTON
WOOL SPOTS (1), MULTIPLE DOT AND BLOT HAEMORRHAGES (2)

54. PREPROLIFERATIVE RETINOPATHY: CONSIST OF MULTIPLE COTTON
WOOL SPOTS (1), MULTIPLE DOT AND BLOT HAEMORRHAGES (2),
VENOUS CHANGES (3)

55. EXUDATES. AN EXAMPLE OF SEVERE MACULAR
EDEMA

56. MA

57. HE

58. CWS

59. FLAME-SHAPED HEMORRHAGE

60. VENOUS BEADING

61. IRMA

62. NVE

63. VH

64. FIBROUS PROLIFERATION

65. NO DR

66. MINIMAL (BACKGROUND) DIABETIC RETINOPATHY
SHOWING MICROANEURYSMS (ARROWS) ONLY

67. BACKGROUND DIABETIC RETINOPATHY SHOWING
SMALL BLOT HEMORRHAGES (ARROWS)

68. MODERATE-SIZED BLOT HEMORRHAGES
(ARROWS). NOTE ALSO THE VENOUS DILATATION
AND BEADING (ARROWHEAD)

69. HARD EXUDATES FORMING A RING OR CIRCINATE
PATTERN AROUND A LEAKING MICROANEURYSM

70. COTTON WOOL SPOTS IN THE POSTERIOR FUNDUS
IN MODERATE DIABETIC RETINOPATHY (ARROW)

71. VENOUS BEADING ON FUNDUS IMAGE (ARROW)

72. EXTENSIVE VENOUS BEADING

73. “WHITE LINES” (ARROW) CORRESPONDING TO AN
AREA OF VASCULAR CLOSURE

74. LARGE PATCH OF NEW VESSELS EXTENDING
FROM A RETINAL VESSEL (NVE) (ARROW)

75. TWO SITES OF NEW VESSEL GROWTH FROM
DIFFERENT VESSELS (ARROWS)

76. EXTENSIVE LOOPING NEW VESSELS FROM THE
DISC (NVD)

77. NVE

78. SUBHYALOID HEMORRHAGE IDENTIFIABLE BY
“FLUID LEVEL” (ARROW)

79. HE

80. LARGE PATCH OF GLIOSIS ASSOCIATED WITH
NVE

81. NVD

82. DENSE PREMACULAR HEMORRHAGE

83. MULTIPLE DOT AND BLOT HAEMORRHAGES,
MICROANEURYSMS AND HARD EXUDATES

84. DIABETIC MACULOPATHY TREATED WITH LASER

85. MULTIPLE COTTON WOOL SPOTS

86. VASCULAR LOOP IN PREPROLIFERATIVE
DIABETIC RETINOPATHY

87. EXTENSIVE MULTIPLE COTTON WOOL SPOTS
AND NEW VESSELS IN THE SUPEROTEMPORAL
ARCADE

88. SUBHYALOID HAEMORRHAGE (FLUID LEVEL);
OLD PRP SCARS.

89. HAEMORRHAGES

90. MICROANEURYSMS

91. NEW VESSELS

92. BACKGROUND DR
Blot haemorrhage
Exudate
Microaneurism

93. DIABETIC MACULOPATHY
Hard exudate

94. PRE-PROLIFERATIVE DR
Vascular
tortuosity
Haemorrhage
CWS
Microaneurism

95. PROLIFERATIVE RETINOPATHY
NVD NVE
Laser burn scars
Pre-retinal
haemorrhage

96. ADVANCED DIABETIC EYE DISEASE
Preretinal fibrosis and tractional
retinal detachment

97. MICROANEURYSMS

98. INTRARETINAL DOT AND BLOT
HAEMORRHAGES

99. HARD EXUDATES

100. CIRCINATE HARD EXUDATES

101. NVE

102. NVE

103. PRERETINAL HEMORRHAGE

104. VITREOUS HEMORRHAGE

105. NEOVASCULARIZATION

106. RETINAL DETACHMENT

107. FOCAL MACULOPATHY – M1

108. DIFFUSE MACULOPATHY – M1

109. MILD NPDR – R1 (MA)

110. BLOT HEMORRHAGES – R2

111. VENOUS BEADING

112. HEMORRHAGES

113. SEVER NPDR + MACULOPATHY

114. PRE-RETINAL HEMORRHAGE

115. NVD

116. NVD & NVE + MACULOPATHY

117. BLOT HEMORRHAGES

118. DOT HEMORRHAGES

119. HARD EXUDATES

120. COTTON WOOL SPOTS

121. DOT & BLOT IN 4 Q + CWS

122. MACULOPATHY

123. EXUDATIVE MACULOPATHY

124. FIBROVASCULAR MEMBRANE

125. MICROANEURYSMS & HEMORRHAGES

126. MICROANEURYSMS

127. MICROANEURYSMS, HEMORRHAGES & HARD
EXUDATES

128. CIRCINATE HARD EXUDATES

129. NVDS

130. FIBROUS TISSUE

131. NVDS