Wong and Mitchell’s classification (adapted from [80]).
Grading
Retinal signs
Sytemic associations*
Mild retinopathy
Generalized arteriolar narrowing, focal arteriolar narrowing, arteriovenous nicking, opacity (copper wiring) of arteriolarwall, or a combination of these signs
Modest association with risk of clinical Stroke, subclinical stroke,coronary heart disease, and death
Moderate retinopathy
Hemorrhage (blot, dot, or flame shaped), microaneurysm cotton-wool spot, hard exudates or a combination of these signs
Strong association with risk of clinical stroke, subclinical stroke, cognitive decline, and cardiovascular mortality
Severe retinopathy
Moderate retinopathy plus optic disc swelling #
Strong association with mortality
*A modest association is defined as an odds ratio of greater than 1 but less than 2. A strong association is defined as anodds ratio of 2 or greater. #Anterior ischemic optic neuropathy, characterized by unilateral swelling of the optic disk, visual loss, and sectorial visual field loss, should be ruled out.
