Image Galleries - R2 or Not?

R2 or Not? December 2017

Total: 73 responses

Image 1

https://www.eyescreening.org.uk/userFiles/Image/R2%20or%20Not%20Images/004.jpg

Overall Result:

R2: 53%

Not R2: 47%

Broken down by grader level:

Trainee Graders (6)

  • R2: 33%
  • Not R2: 66%

Qualified Graders (48)

  • R2: 58%
  • Not R2: 42%

ROG/L3 Graders (19)

  • R2: 52%
  • Not R2 48%

Comments from those who said R2:

  • IRMA
  • .Multiple blots with some early vessels changes. Would also question optic disc as questionnable vessels seen possible R3
  • Patches of IRMA located at 6 and 9 o'c position to the disc.
  • Selected R2 because R2 features were visible (IRMA) however on TaT would grade R3A due to vessels visible on optic disc. To me these are too long and tortuous to just be IRMA

Comments from those who said NOT R2:

  • Highly suggestive of NVD
  • Image 1 appears to have NVD and so I would grade this image R3
  • I can see Irma present but also nvd
  • I would call this in as NVD.
  • I would grade this R3a for possible NVD

Image 2

https://www.eyescreening.org.uk/userFiles/Image/R2%20or%20Not%20Images/005.jpg

Overall Result:

R2: 56%

Not R2: 44%

Broken down by grader level:

Trainee Graders (6)

  • R2: 33%
  • Not R2: 66%

Qualified Graders (48)

  • R2 58%  
  • Not R2: 42%

ROG/L3 Graders (19)

  • R2: 58%
  • Not R2 42%

Comments from those who said R2:

  • Not enough Hges in this view but early IRMA
  • IRMA inferior to disc
  • Superior edge of image only
  • Patch of irma supero-temporal region close to edge of image
  • Graded R2 due to IRMA-like appearance of vessels in superieor aspect of image. Some tortuous vessels just visible below optic disc but in isolation I would be cautious about calling those IRMA since they are situated within the nerve bundle near the optic disc where fine vessels can appear tortuous in the absence of any other retinopathy/ischaemic feature.

Comments from those who said NOT R2:

  • R1
  • Very borderline image for me. There are some fine vascular changes inferior to the disc, very akin in appearance and location to tourtuosity so not a clear cut IRMA marker for me, would love to see some history or even a disc view to see if anything pushed it up to R2. I would be sending for DS as being on the borderline of R2 rather than thinking of this at as being on the border of proliferative disease.
  • R1

Image 3

https://www.eyescreening.org.uk/userFiles/Image/R2%20or%20Not%20Images/006.jpg

Overall Result:

R2: 82%

Not R2: 18%

Broken down by grader level:

Trainee Graders (6)

  • R2: 83%
  • Not R2: 17%

Qualified Graders (48)

  • R2: 83%
  • Not R2: 17%

ROG/L3 Graders (19)

  • R2: 79%
  • Not R2 21%

Comments from those who said R2:

  • Small area of reduplication
  • MBH with a scattering of IRMA
  • Multiple blot haemorrhages
  • mbh and irma
  • No nasal view to confirm blot haems nasally also but 8 blot haems larger than diameter of smallest vein as crosses disc margin
  • Suspicious vessel 4 at o'clock, looks to be looping back on itself

Comments from those who said NOT R2:

  • I think close to being an R2
  • would grade R3, there is a suspicious vessel patch of possible NVE inferior
  • I think this is R3A (NVE inferior temporal)
  • Suspicious that there are NVE. Would grade R3.
  • Not without seeing nasal shot as it could be MBH if the activity continues.

 

 

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