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.