Amber Priority. Image Library

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1 Amber Priority Image Library

2 Amber flag Diabetic Maculopathy (M1) Pre-proliferative Diabetic Retinopathy (R2) Old, treated and now inactive DR (R1/M0/P1or R0/M0/P1) Where only partial or incomplete images can be achieved Other ocular conditions with retinal signs ALWAYS MAKE NOTES TO INFORM THE PROGRAMME WHY YOU HAVE FLAGGED AS AMBER

3 Diabetic Maculopathy (M1) Exudates within macula Flag as amber if any exudates at all on macular image If unsure whether they are drusen, still flag as amber Blood spot within 1 disc diameter (DD) of the fovea with a VA of or worse Usually significant background diabetic retinopathy (BDR) as well

4 Inner Circle: <1DD; Outer Circle: rough confines of the macula Exudates

5 Within 1 DD of fovea Subtle Exudates

6 VA still good; Younger patient with prominent surface reflexes Para-foveal exudate

7 Exudate patch

8 Exudates, trailing towards fovea

9 Multiple exudate patches Exudates

10 Fellow eye; Note larger blot haemorrhages as well Exudates

11 Pre-proliferative DR (R2) Multiple blot haemorrhages Flag as amber if there are more than 5 blood spots visible or more than one large haemorrhage Vessel changes Flag as amber if there are any unusual vessels Intra-retinal Micro vascular anomaly (IRMA) Venous Beading Venous reduplication Cotton wool spots Flag as amber if there are any white, fluffy lesions

12 Nasal to disc; Classic position IRMA

13 Subtle, but note significant BDR and Cotton-wool spot nearby IRMA

14 Note some blots centrally; More significant DR Larger and more numerous haemorrhages

15 Also, exudates Multiple blots and CWS

16 Also exudate Multiple blots and cotton wool spots

17 Note narrowing of vessel as well Venous Beading

18 Several IRMA, beading, venous dilatation, narrowing and sheathing Multiple nasal vessel changes

19 Reduplication with early beading

20 In more detail Reduplication

21 Old laser scars Always flag at least as amber if there are any signs of old laser scars on any images If there also appears to be New vessels or fibrosis: Flag as Red Follow the reporting protocol for red cases in Section 13 of the Screening Protocol

22 Mild, but significant BDR Mild laser photo-coagulation

23 Mild BDR Peripheral scatter laser photo-coagulation

24 Signs of peripheral scatter Laser Photocoagulation Very mild BDR otherwise; Still requires amber flag

25 No NVD/NVE or Fibrosis, so should only be set as amber Extensive laser scarring

26 Other ocular conditions Flag as amber if there are any signs of known non-dr conditions on the images Flag as amber if there are any signs that could indicate non-dr conditions on the images

27 Other ocular conditions Vein Occlusions Usually asymmetrical lesions Embolism Wet AMD Dry AMD Glaucoma Disc splinter haemorrhage Pale, cupped disc Optic Nerve disorders Choroiditis Vitreous disorders

28 Note collateral disc vessels Central Retinal Vein Occlusion

29 Gold embolism

30 Glaucoma

31 Glaucoma

32 Suspicious for glaucoma Disc haemorrhage, not DR

33 VA moderately reduced or no change Papilloedema

34 Fellow eye, almost always bilateral Papilloedema

35 More likely to be unilateral and VA reduced Papillitis

36 Comparison with previous image Left side: Last screening episode Right side: current episode

37 Central swelling Wet AMD

38 Central exudation and pigment dispersion Wet AMD

39 Pigment dispersion and Drusen Dry AMD

40 Dry AMD

41 Chorio-retinal scar

42 Melanoma

43 Retino-Schisis

44 Retino-Schisis

45 AKA Macular Pucker/Epi-macular membrane (EMM) Cellophane Maculopathy

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