Monday, February 1, 2010


This is just a simple algorithmic method. Its not very accurate but simple enough to be used when assessing simple typical cases.

Almost 4 years of study, and I wasn't sure what I knew about DR. A 3 days program seemed to turn the tide (a lil).

Thank you to DOVS.



  1. Wow..simple algorithm..Good job n Credit to Zul.


  2. congrats zul... perhaps u would want to to edit some of the phrase to more scientific terms and of course exclude 'ada mata ' part and etc .... So, it would become more acceptable and publish it somewhere...

  3. zul- applause!! turn the tide?. uh, da pro nie

    ain- i agree with d scientific terms.. but as u can see it comes from zul, cut him some slack laa.. i'd say creatively simple or simply creative.. both would do la, hehe ^^

    i'd like to share an experience during my ORC posting last wiks..

    - this pt (57/M/M) came for follow up of cataract extraction
    - has DM and HPT for years (not noted since when)- on medication 6/12

    Fundus camera revealed
    -2 cotton wool spots appearance at inferior and superior temporal
    -no microaneurysm or exudates noticed
    -macula looks completely fine
    -but then i cant help but noticed an appearance of slight venous beading at inferior temporal quadrant..

    i 'baca' this kondisi with Dr H till we came to a complete dx with Dr K..

    based on innovative algorithm above with ur extra knowldge, wut stage would best describe this pt.. a snap yet i'd like to know ur verdicts ^^

  4. since the pt had venous beading, we can classify the DR as severe NPDR


  5. Salam.

    tq. tq all.

    to ain:

    sometimes its a lot easier to remember a 2-hr-humor than a 2 mins lecture. lgpn ni jes algorithm simple. x applicable utk sume case. bt can b a gud starting point 4 people yg b4 dis agk bebal psl DR. kalo publish somewhere, mesti ophthal, MO, AMO, staff nurse, @ jururawat masyarakat ckp "hek eleh budk undegrad nie... 2pn nk kecoh..."

    to DD:
    turn d tide - of course from bebal to iqbal. ataupn ko nk aku sbut from bebal to naufal?

    bout d case... i thnk Br. Syah is right. lgpn, algorigthm ni jes utk simple typical cases. As Prof Adzrin said, most cases are atypical. ok la. lps niaku cube wat criteria-based nye assessment lk.

    sekian, trimas.

    may the peace be with you.

    p/s to DD: aku nk 6 marks....

  6. ok, so sir n zul said severe..

    ain would like to comment on this one too.. ill wait for her then.


    p/s to ZUL: take mine je.. xyah amek others.. i feel responsible for this.

  7. I would say it is a moderate NPDR with no maculopathy.
    (hope that Ain will agree with my verdict)

    Of course, it's not a mild one because there are cotton wool spots already.

    Meanwhile, to say that it's severe, it has to fulfill at least one of these criteria:

    1) 20 microaneurysms in each of 4 quadrants --> not observed in this case

    2) venous beading in 2 or more quadrants --> in this case, there is only one venous beading, right?

    3) IRMA in even only 1 quadrant --> not observed in this case

    p/s 1: amboi dd... sejak workshop aritu, u memang sangat alert ngan venous beading kan~

    p/s 2: I've never heard of "venous beading" before the workshop... huhu

  8. ok so now we have 2 verdicts- severe n moderate..

    still no reponse from ain.. ill wait till abes lunar new year celebration.. if ain still xjwb, i juz reveal, hehe..

    @kak dilly: btul kak dil, venous beading +iRMA sumenye benda BARU bg i.. thanks to DR workshop ^^

  9. haha... forgot bout this case already... miane..
    i could not help to agree with kak dil... since venous beading is only in one quadrant, the diagnosis could probably be moderate NPDR with no maculopathy...
    however, this case seem a bit weird too me. patient has no microaneurysm , exudate or dot blot haemorrhge which are earlier sign of DR, instead he only got venous beading which is more severe...
    since this patient also has hypertension, i start to wonder wether venous beading could also be a result from hypertension. Do u guys have any opinion?

  10. tq ain for ur 'quick' response =P .. ur curiousity were same as mine during the 'baca' moment.. i wonder where are d earlier signs of DR..

    likewise kak dil n ain, i came to 'moderate NPDR with no maculopathy'.. Dr H agreed with my dx but not Dr K..

    since there is no earlier signs of DR traced from this pt's fundus- we can classify him as having 'MILD NPDR with no maculopathy'..

    yes, venous beading is there yet it cannot be outweighed in contemplating dx to a higher degree of severity with absent of other earlier signs.. plus, only a mild one presents, thus pt can still be noted as having a mild stage..

    as zul said d algorithm wont be applicable in all cases.. sometimes, logic plays a vital part in determining the dx..

    tq all for ur participation.. it was good to refresh d memory ^^

  11. From DR workshop, the specialist said that since there is beading, we classify it as severe. or maybe moderate-severe case.

    this classification is very subjective . Thus, just follow your GURU. Saya berguru during DR workshop with the specialist(I cant remember her name). So, for me the answer is still mod-severe or severe NPDR.

    -no microaneurysm or exudates (MA N EXUDATE are happened at OUTER PLEXIFORM LAYER
    2 cotton wool spots appearance at inferior and superior temporal & Venous beading are happened at GCL and nerve fiber layer which are inner compared to OPL..Mana bisa kita diagnosisnya as a mild NPDR.





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