Aim To analyse a new grading protocol for clinically significant diabetic macular oedema (CSME) based on spectral domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA).

Methods 56 eyes of 40 patients with CSME were examined by Cirrus OCT (Carl Zeiss Meditec), Spectralis HRA and OCT (Heidelberg Engineering) on the same day. Three graders analysed images based on a newly developed grading protocol integrating all relevant information from OCT and FA. The protocol defined four categories: (1) subretinal fluid (category ‘S’); (2) the planimetrically measured oedematous area (category ‘A’); (3) vitreo-retinal interface abnormalities (category ‘V’); and (4) CSME aetiology (category ‘E’) defining the leakage source.

Results The new grading protocol allowed for a detailed characterisation of each individual type of CSME. It defines four aetiological types of CSME and analyses four further categories important in diagnosis and during follow-up in clinical and study settings. Atrophic, a new type of CSME, was described and characteristic combinations of triggers of CSME were revealed. Inter-grader agreement, analysed using Fleiss’ κ values for Cirrus OCT and Spectralis OCT, respectively, was good for ‘S’ (0.9; 0.82), ‘A’ (1.0; 1.0) and ‘E’ (range 0.63–0.8; 0.57–0.77), and lower for ‘V’ (0.25; 0.42).

Conclusions The ‘SAVE’ grading protocol of CSME integrates information from two imaging techniques, OCT and FA. Its clinical approach allows examiners to define and further categorise clinical characteristics to find tailored therapeutic strategies.