CHS Retinal Light Box Grading Form Draft 8-19-97

 

FIELD CENTER __ __ PARTICIPANT ID __ __ __ __ __ __ __

NAMECODE __ __ __ __ __ __ EYE __ __ __ BATCH __ __ __ __ PHOTO DATE __ __ /__ __ /__ __

 
Focus Artifacts No Yes Disc Obscured or Missing No Yes
0 2
1 Good Haze 0 2
2 Fair Dust / dirt 0 2 Macula Obscured or Missing 0 2
3 Borderline Lashes 0 2
4 Inadequate Arc 0 2 Gradability
8 Cannot grade Uneven illum / macula 0 2 1 Gradable
Uneven illum / edge 0 2 2 Impaired
Uneven illum / disc zone 0 2 3 Ungradable
Field Definition Total blink 0 2
Other 0 2
1 Good
2 Fair
3 Poor Comments:___________________________________________________________________________
4 Can’t Grade

 

 
 ARTERIOLAR CHANGES
Disc Arterial Abnormalities Zone A Arterial Abnormalities       Generalized Narrowing of Arterioles  
           
0 0 None 0 None
1 1 Questionable 1 Questionable
2 2 Definite, 1 or 2 vessels 2 Definite, 1 or 2 vessels
3 3 Severe, ³3 vessels 3 Severe, ³3 vessels
8 8 Cannot grade 8 Cannot grade

 
Focal Narrowing of Arterioles, Quadrants Sheathing of Arterioles, Quadrants
ST SN IN IT ST SN IN IT
0 0 0 0 None 0 0 0 0 None
1 1 1 1 Questionable 1 1 1 1 Questionable
2 2 2 2 Mild, 1/2 DD total length 2 2 2 2 Mild, <1/2 DD total length
3 3 3 3 Moderate, <2DD total length 3 3 3 3 Moderate, <2DD total length
4 4 4 4 Severe, ³2DD total length 4 4 4 4 Severe, ³2DD total length
8 8 8 8 Cannot grade 8 8 8 8 Cannot grade

 

 
Changes in A/V Crossings, Quadrants
ST SN IN IT
0 0 0 0 None
1 1 1 1 Questionable
2 2 2 2 Definite, < Std. 9
3 3 3 3 Severe, ³ Std. 9
8 8 8 8 Cannot grade

 
LESIONS OF DIABETIC RETINOPATHY

 

 

 
Hemorrhages/

Microaneurysms

 Number of

Microaneurysms

 Number of Retinal

Hemorrhages

 Type of

Retinal Hemorrhage
0 None 0 None 0 None 0 None
1 Questionable 1 Questionable 1 Questionable 1 Questionable
2 Definite 2 1 Ma 2 1 RH 2 Flame hemorrhage only
3 ³Std. Photo #1 in all 4 quadrants 3 2 Ma’s 3 ³ 2 RH’s 3 Blot hemorrhage only
4 ³Std. Photo #2A 4 3 Ma’s 8 Cannot grade 4 Blot and flame hemorrhages
5 ³Std. Photo #2A in 2 or 3 quadrants 5 4 Ma’s 8 Cannot grade
6 ³Std. Photo #2A in all 4 quadrants 6 ³5 Ma’s
8 Cannot grade 8 Cannot grade

 

  
Hard Exudate Soft Exudate Macular Edema Laser Photocoagulation
0 None 0 None 0 None 0 None
1 Questionable 1 Questionable 1 Questionable 1 Questionable
2 Definite 2 Definite 2 Present, inferred from HE/other* 2 Focal Rx only
8 Cannot grade 8 Cannot grade 3 CSME, inferred from HE/other† 3 Scatter and/or local Rx
4 Center involved, inferred from HE/other† 4 Focal and scatter Rx
8 Cannot grade 8 Cannot grade

 

 
IRMA Venous Beading
0 None 0 None
1 Questionable 1 Questionable
2 Definite 2 Definite
3 Definite in all 4 quadrants 3 Definite in 2 or more quadrants
4 > Std. Photo #8A 8 Cannot grade
8 Cannot grade

 

 

 
NVD NVE VH/PRH FP
0 None 0 None 0 None 0 None
1 Questionable 1 Questionable 1 Questionable 1 Questionable
2 < Std. #10A 2 < 1/2 DA 2 < 1 DA 2 Definite
3 > Std. #10A 3 > 1/2 DA 3 > 1 DA 8 Cannot grade
8 Cannot grade 8 Cannot grade 8 Cannot grade

 

 
 DIABETIC RETINAL LEVEL SUPPORTING EVIDENCE
90 Cannot grade 903 Cannot grade for proliferative retinopathy
902 Cannot grade for background retinopathy; no proliferative retinopathy present
901 Cannot grade for microaneurysms; no other background retinopathy present
85 Advanced PDR† 852 Retinal detachment at center of macula
851 Macula obscured by VH and/or PRH
81 Advanced PDR† 811 VH and/or PRH, cannot grade for NVD and/or NVE, center attached
75 DRS HRC† 751 NVD > Std Photo #10A with VH and/or PRH
71 DRS HRC† 714 NVD > Std Photo #10A
713 NVD < Std Photo #10A with VH and/or PRH
712 NVE > 1/2 DA with VH and/or PRH
711 VH and/or PRH > 1 DA
65 Moderate PDR† 654 NVE < 1/2 DA with VH and/or PRH
653 NVD < Std Photo #10A
652 NVE > 1/2 DA
651 VH and/or PRH < 1 DA
61 Mild PDR† 612 NVE < 1/2 DA
611 FPD and/or FPE
53 Severe NPDR† 534 Venous beading in 2-4 quadrants
533 IRMA > Std Photo #8A
532 H/Ma > Std Photo #2A in each of the 4 quadrants
531 Two or more of level 47 characteristics
47 Moderately severe NPDR* 474 Venous beading in one quadrant
473 H/Ma > Std Photo #2A in 2 or 3 quadrants
472 IRMA in all 4 quadrants
471 Both IRMA and H/Ma characteristics from level 43
43 Moderate NPDR* 433 IRMA in 1 to 3 quadrants
432 H/Ma > Std Photo #2A in 1 quadrant
431 H/Ma > Std Photo #1 in each of the 4 quadrants
35 Mild NPDR* 355 Soft exudate
354 Hard exudate
353 Retinal hemorrhage
352 Questionable SE, IRMA or venous beading
351 Venous loop > code 2
20 Microaneurysms only 201 Microaneurysms only
15 DR questionable 151 Retinal hemorrhage, no microaneurysms
14 DR questionable 143 IRMA, no microaneurysms
142 Soft exudate, no microaneurysms
141 Hard exudate, no microaneurysms
10 DR absent 101 Microaneurysms and other lesions absent

 
 OTHER OCULAR LESIONS

 
N Q Y N Q Y
0 1 2 Central artery occlusion† 0 1 2 Cellophane reflex
0 1 2 Branch artery occlusion† 0 1 2 Surface wrinkling retinopathy
0 1 2 Central vein occlusion† with or without tension lines
0 1 2 Branch vein occlusion† 0 1 2 Any drusen present in photo
0 1 2 Hollenhorst plaque * 0 1 2 Soft drusen within 2DD’s of macula
0 1 2 Asteroid hyalosis 0 1 2 RPE depigmentation
0 1 2 Hyperpigmentation
0 1 2 Lg cup/disc ratio* 0 1 2 SSR detachment*
0 1 2 RH within disc margin* 0 1 2 Subretinal hemorrhage†
0 1 2 Peripapillary atrophy
0 1 2 Papillary swelling* 0 1 2 Subretinal fibrous*
0 1 2 Other disc abnormality 0 1 2 Geographic atrophy*
0 1 2 Glial / vitreous thickening 0 1 2 Chorioretinal scars
0 1 2 Medullated nerve fibers 0 1 2 Nevus
0 1 2 Retinal detachment†
0 1 2 Other (see comment)

 

COMMENTS______________________________________________________________________________________________________________

 

 
Retinal Notification Status
0 No notification needed
1 Yes, retinal alert sent: date ________________
2 Yes, routine notification sent: date: _____________
3 Cannot grade for notification conditions

  
Grader # ___ ___ Initials ___ ___ ___ Date Graded: ________________________

 

 

* Routine retinal notification required

† Retinal alert required

 

 Return to Light Box Grading Protocol

 

2/17/98