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

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