Ophthalmology Notes: Grading & Classification

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RAPD grading (as per the l V system of Bell et al)

Grade I - Initial weak constriction with greater redilatation

Grade II - Initial stall and greater redilatation

Grade III - Immediate pupillary dilatation

Grade IV - Immediate pupillary dilatation following 6 seconds of illumination

Grade V - Immediate pupillary dilatation with no secondary constriction at all

Amaurotic	This is seen when one eye has no perception of light. The pupil of this eye only constricts when light is shone into the other eye. When the light is shone back into the eye with no perception of light the pupil rapidly enlarges against the light.
3–4+	The pupil enlarges as soon as the light is swung from the normal eye into the abnormal eye.
1–2+	The pupil enlarges, but only after a short delay, after the light is swung from the normal eye into the abnormal eye.
Subtle/ trace	Sometimes the pupils of both eyes can enlarge in the short time interval between shining the light in the normal eye and the abnormal eye. If this happens, the pupil of the abnormal eye may constrict a little bit before enlarging.

Grade	Amount of vitreous flare/haze
0	No flare
0.5+	Trace
1+	Clear optic disc and vessels, hazy nerve fibre layer
2+	Hazy optic disc and vessels
3+	Optic disc visible
4+	Optic disc not visible

Vitreous Cells Grading

Microhyphema	Red blood cells suspended in the AC without the formation of a layered clot
Grade 1	Layered blood occupying less than one-third of the anterior chamber
Grade 2	Layered blood filling one-third to one-half of the anterior chamber
Grade 3	Layered blood filling one-half to less than the total volume of the AC
Grade 4	Blood filling the entire volume of the AC
"Eight-ball"	Total hyphema of blackish-purplish color

Stages	Functional status	Features
Ia	Glaucoma suspect- Low Risk	Fields normal Discs: CD ratio<0.3, No asymmetry, Pink and uniform neuroretinal rim
Ib	Glaucoma suspect- High Risk	Fields normal Positive family history Pigment dispersion/ pseudoexfoliation, Diabetes Large physiological cups
II	Glaucoma damage- Early	Discs- CD rati0>0.3, Pink rim with variable rim width Fields- incomplete arcuate/nasal step
III	Glaucoma damage- Late	Discs- CD ratio >0.6, Pale rim with variably narrow rim width Fields- complete arcuate
IV	Glaucoma damage- End Stage	Discs- End stage cupping Fields- Temporal island