Update on Diagnosis and Treatment of Diabetic Retinopathy: A Consensus Guideline of the Working Group of Ocular Health (Spanish Society of Diabetes and Spanish Vitreous and Retina Society)

Table 4

Criteria and degree of urgency for referral of a patient with DR to the ophthalmologist.

Lesions requiring immediate assessment by the ophthalmologist	Proliferative retinopathy	(i) New vessels on the optic disc or at any location in the retina
		(ii) Preretinal hemorrhage
	Advanced diabetic retinopathy	(i) Vitreous hemorrhage
		(ii) Fibrotic tissue (epiretinal membrane)
		(iii) Recent retinal detachment
		(iv) Iris neovascularization
Lesions that should be referred to the ophthalmologist for assessment as soon as possible	Preproliferative retinopathy	(i) Venous irregularities
		(ii) Multiple hemorrhages
		(iii) Multiple cotton-wool exudates
		(iv) Intraretinal microvascular abnormalities (IRMA)
	Nonproliferative retinopathy with macular involvement	(i) Decreased visual acuity uncorrected with a pinhole occluder (suggestive of macular edema)
		(ii) Microaneurysms, hemorrhages, or exudates within less than one disc diameter of the center of the macula (with or without vision loss)
	Nonproliferative retinopathy without macular involvement	(i) Hard exudates with a circinate or plaque pattern in the major temporal vascular arcades
	Any other finding that the observer could not be interpreted with a reasonable degree of certainty
Lesions requiring follow-up control (every 6–12 months) but should not be referred to the ophthalmologist	Nonproliferative retinopathy	(i) Hemorrhages or microaneurysms occasionally or hard exudates beyond one disc diameter of the center of the macula
		(ii) Isolated cotton-wool exudates without preproliferative associated lesions