For the hypertensive retinopathy stadiation there are two main classifications:
1) The Keith-Wagener-Barker classification
2) The Mitchell-Wong classification.
There are few differences between these grading systems.
I would know which one is preferable for a clinical research.
Thank you.
I suggest you to adopt the Keith-Wagener-Barker classification. :)
Best regards!
Dear Megelio
The Keith-Wagener-Barker classification of retinopathy actually combines the arteriosclerotic changes and hypertensive retinopathy. the arteriosclerotic changes could be age related in absence of hypertension. so if you want to study its prognostic relevance, go for Mitchell-Wong classification.
Yes, the Mitchell_Wong classification is a simplified three-grade classification based on Keith-Wagener-Barret scheme, and takes into account the association between hypertensive retinopathy and cardiovascular risk. The classification depends on to the goal of your study.
Hello, and thank you all for answer to my question.
The classical classification of hypertensive retinopathy was provided by the Keith–Wagener–Barker (KWB) in 1934, and it is defined by four grades of retinal signs: grade 1 (narrowing), grade 2 (arteriovenous crossings), grade 3 (hemorrhagesand exudates), and grade 4 (papilloedema).
Only in 2004 Mitchell and Wong proposed a new simplified grading system combining grades 1 and 2 of KWB in only one stage . In table attached there are more specifications about. Actually KWB scale is still - and obviously- the most cited.
I'm working on a clinical study for the cardiology unit of my own hospital (patients who take antihypertensive drugs without any others cardiac medications) where we have to classify the hypertensive retinopapthy from the early stage using IR imaging. I think that probably the KWB classification could be more useful to better describe the early stage of retinopathy but I would be sure that i'm right... thank you forany explanations...
The arteriosclerotic and hypertensive retinopathy changes in early stages grade I and II are similar in KWB while different in grade III and IV
if you want KWB, do consider age as cofounding factor or exclude elderly
AS retinopathy
grade I - altered AV ratio
grade II - AV crossing changes
grade III - copper wire
grade IV - silver wire
Ok, thank you very much for this specification; older patients are already excluded from this study.
Best Regards.
Michele Meglio let me introduce to you the most recent (2017) and most simple Grading System of hypertensive retinopathy. It describes only three grades based upon both the most common signs (morphological changes in retinal vasculature) and most common symptom.
Imtiaz’s grading of Hypertensive Retinopathy which has described three grades of hypertensive retinopathy, Grade 1: Silver wiring of arterioles with AV nipping and headaches. Grade 2: Same as Grade 1 with flame- shaped haemorrhages, soft exudates and floaters. Grade 3: The same as Grade 2, with papilloedema and amaurosis fugax.
Ref. Shah SIA: Concise Ophthalmology Text & Atlas (ISBN: 978-969-637-361-2) . 5th ed. Paramount Books Pvt. Ltd. 2018: 85-95.
Most of the widely available text-books and literatures follow The Keith-Wagener-Barker classification for grading hypertensive retinopathy. It also used in clinic to grade most of the hypertensive patients who present with retinopathy.
Dear Pabita Dhangel, Sorry I have read your answer today. Your statement is absolutely correct that most of the books follow Keith-Wagener-Barker classification for grading hypertensive retinopathy. But in this growing and rapidly developing scientific basis you have to be factual about the ground realities otherwise either you will be left behind in modern patient care or you will just be theoretical. The newest classification "Imtiaz’s grading of Hypertensive Retinopathy" which has described fewest grades i.e. three grades of hypertensive retinopathy which is based on both signs and symptoms (as you know, no previously available classifications have included symptoms in addition to signs) therefore no classification is so simple, so safe and so productive than "Imtiaz’s grading of Hypertensive Retinopathy". If you need, I can send you a simple comparative presentation on various classifications so that you can your self decide.
- Badges
- Science topic
- Similar topics
- Data Mining
- Classification