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Severe NPDR — RACP Adult Medicine MCQ

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ModerateEndocrinologySevere NPDRRACP Adult Medicine

A 55-year-old man with poorly controlled type 2 diabetes (HbA1c 91 mmol/mol) has fundoscopy showing dot and blot haemorrhages, hard exudates, microaneurysms, and cotton-wool spots bilaterally. There are no new vessels. Visual acuity is preserved. What is the most likely fundoscopy diagnosis?

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Correct answer: E — Severe non-proliferative diabetic retinopathy

Dot/blot haemorrhages, microaneurysms, hard exudates, and cotton-wool spots without neovascularisation is non-proliferative diabetic retinopathy. The 4-2-1 rule defines severe NPDR: haemorrhages in 4 quadrants, venous beading in 2 quadrants, or IRMA in 1 quadrant. Severe NPDR has ~50% risk of progression to PDR within 1 year. Urgent ophthalmology referral is needed.

Reference: NHMRC – 2024 – Diabetic Retinopathy Guidelines; ADS 2024