Classification of hypertensive retinopathy by Wong and Mitchell26
| Grades | Description | Systemic associations | ||
|---|---|---|---|---|
| *Modest: risk and odds ratios of >1 but <2. †Strong: risk and odds ratios of >2. ‡Anterior ischaemic optic neuropathy, characterised by unilateral optic disc swelling, visual loss, and sectoral visual field loss, should be excluded neuropathy, characterised by unilateral optic disc swelling, visual loss, and sectorial visual field loss, should be excluded. | ||||
| No retinopathy | No detectable retinal signs | None | ||
| Mild retinopathy (retinal arteriolar signs only) (figs 1, 2) | One or more of the following arteriolar signs: • Generalised arteriolar narrowing • Focal arteriolar narrowing • Arteriovenous nicking • Arteriolar wall opacity (silver wiring) | Modest* association with risk of clinical stroke, subclinical stroke, coronary heart disease, and mortality. | ||
| Moderate retinopathy (fig 3) | One or more of the following retinal signs: • Haemorrhage (blot, dot, or flame shaped) • Microaneurysm • Cottonwool spot • Hard exudates | Strong† association with risk of clinical stroke, subclinical stroke, cognitive decline, and cardiovascular mortality | ||
| Malignant retinopathy (fig 5) | Moderate retinopathy plus optic disc swelling‡ | Strong association with mortality | ||