Classification and Referral Policy for Diabetic Retinopathy Pathology
Resulting from our Retinopathy Screening Programme
Introduction

This table details the pathology that may be identified as a result of the DR Screening Programme. It provides for each result classification a description, notes if referral is required and details the management action to be undertaken by our screening programme. These result classifications are as defined within NSC workbook.

The management action to be undertaken by the programme is detailed for each disease classification (all patients will be issued with a result letter). The DR Screening Programme will undertake all referrals on behalf of the Patient’s GP Practice. There is no need for a further referral from General Practice. General Practice will be informed of all findings.

Result Classification
& Description		 Referral Required Management Action by DR Screening Programme
Retinopathy Level 0
None		 No Schedule for Annual Review, Notify Practice
Retinopathy Level 1
Background microaneurysm(s) retinal haemorrhage(s) ± any exudates 		No Schedule for Annual Review, Notify Practice
Retinopathy Level 2

Pre-proliferative
venous beading
venous loop or reduplication
intraretinal microvascular abnormality (IRMA)
multiple deep, round or blot haemorrhages
(CWS - careful search for above features)

 Referral Referral to the Ophthalmology Department
Retinopathy Level 3

Proliferative
new vessels on disc (NVD)
new vessels elsewhere (NVE)
pre-retinal or vitreous haemorrhage

pre-retinal fibrosis ± tractional retinal detachment

 Urgent Referral Undertake Urgent Referral to the Ophthalmology Department.  (Target to be seen within 10 days.)
Maculopathy (M)

exudate within 1 disc diameter (DD) of the centre of the fovea
circinate or group of exudates within the macula
retinal thickening within 1DD of the centre of the fovea (if stereo available)

any microaneurysm or haemorrhage within 1 DD of the centre of the fovea only if associated with a best VA of < 6/12 (if no stereo)		 Urgent Referral Undertake Urgent Referral to the Ophthalmology Department.  (Target to be seen within 10 days.)
Photocoagulation (P)

focal/grid to macula
Peripheral scatter

 No

Evidence of Previous Treatment found, Annual Review.
Other lesions (OL)

focal/grid to macula
Peripheral scatter

 -

See Non-DR Pathology Results Classifications (patient actions include, Notify Practice, Referral and Urgent Referral)

Ungradeable/unobtainable (U)

Cataracts or other Media Opacity

 Referral for Bio-Microscopy

Refer Patient for Bio-Microscopy Screening Procedure
Unscreenable (US)

discharge, inform GP
(option to recall for further photos if purely technical failure (TF))

Organise further screening appointment

 

Referral for Bio-Microscopy

If Technical Failure – TF
Requires further screening, for example, due to camera failure. Patient to be invited to book a further screening appointment.

If not Technical Failure -
Refer Patient for Bio-Microscopy Screening Procedure