Classification of diabetic retinopathy and diabetic macular edema

Classification	Observable findings
No apparent retinopathy	No abnormalities
Mild nonproliferative diabetic retinopathy	Microaneurysms only
Moderate nonproliferative diabetic retinopathy	More than just microaneurysms but less than severe nonproliferative diabetic retinopathy*
Severe nonproliferative diabetic retinopathy	No signs of proliferative retinopathy and any of the following: More than 20 intraretinal hemorrhages in each of 4 quadrants Definite venous beading in 2+ quadrants Prominent intraretinal microvascular abnormalities in 1+ quadrant
Proliferative diabetic retinopathy	At least 1 of the following: Neovascularization Vitreous/preretinal hemorrhage
No apparent macular edema	No apparent retinal thickening or hard exudates in posterior pole
Diabetic macular edema is present^¶	Some apparent retinal thickening or hard exudates in posterior pole

* Other findings may include hard exudates, cotton wool spots, or dot and blot hemorrhages.

¶ Diabetic macular edema is categorized as center involved (retinal thickening in the macula that involves the central subfield zone) or non-center involved.

From: Bastos de Carvalho A, Ware SL, Lei F, et al. Implementation and sustainment of a statewide telemedicine diabetic retinopathy screening network for federally designated safety-net clinics. PLoS One 2020; 15:e0241767. Copyright © 2020 The Authors. Adapted under the terms of the Creative Commons Attribution License 4.0.

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Classification of diabetic retinopathy and diabetic macular edema