Hypertensive Retinopathy Classification (Wong-Mitchell)

Grade Stage Ophthalmoscopic signs Systemic associations
1 Mild retinopathy One or more of the following arteriolar signs:
- Generalised arteriolar narrowing
- Focal arteriolar narrowing
- Arteriovenous nicking
- Arteriolar wall opacity (silver wiring)
Modest association (risk and odd ratios of >1 but <2) with risk of clinical stroke, sublclinical stroke, coronary heart disease and mortality
2 Moderate retinopathy One or more of the following arteriolar signs:
- Haemorrhage (blot, dot or flame shaped)
- Microaneurysm
- Cottonwool spot
- Hard exudates
Strong association (risk and odds ratios of >2) with risk of clinical stroke, subclinical stroke, cognitive decline and cardiovascular mortality
3 Malignant reinopathy Moderate retinopathy plus optic disc swelling Strong association with mortality

A Keith-Wagener-Barret simplified three-grade classification scheme, proposed by Wong and Mitchell (2004), based on the strenght of the reported associations between hypertensive retinopathy and cardiovascular risk.

References

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