Diabetic Retinopathy (DR) and
Diabetic Macular Edema (DME) can
become more severe at any time1

Help Detect Progression of Disease Severity1-4

A severity scale can help identify and standardize the classification of the
clinical features of DR at various stages, allowing for1-4:

Fundoscopic image of mild Nonproliferative Diabetic Retinopathy

Mild Nonproliferative DR (NPDR)

  • Hard exudates, soft exudates, hemorrhages, venous beading, or IRMA, but less
    extensive than moderate NPDR1-4

Images captured at different visits.

Fundoscopic image of moderate Nonproliferative Diabetic Retinopathy

Moderate NPDR

  • More extensive findings than mild NPDR, but less extensive than
    moderately severe NPDR1-4

Images captured at different visits.

Fundoscopic image of moderately severe Nonproliferative Diabetic Retinopathy

Moderately Severe NPDR

Any of the following1-4:

  • Mild IRMA in 4 quadrants
  • Severe retinal hemorrhages in 2-3 quadrants
  • Venous beading in 1 or more quadrants

Images captured at different visits.

Fundoscopy of severe Nonproliferative Diabetic Retinopathy

Severe NPDR

Any of the following (4-2-1 rule) and no signs of proliferative DR (PDR)1-4:

  • Severe intraretinal hemorrhages and microaneurysms in each of 4 quadrants
  • Definite venous beading in 2 or more quadrants
  • Moderate IRMA in 1 or more quadrants

Images captured at different visits.

Fundoscopy of Proliferative Diabetic Retinopathy eye


One or both of the following1-4:

  • Neovascularization
  • Vitreous/preretinal hemorrhage

Images captured at different visits.

Images courtesy of Dr. Mohammad Rafieetary. Used with permission.

Scale is adapted from the ETDRS-DRSS, an established grading scale for measuring the severity of DR, as well as from the AAO.

You can download
this scale in our
resource section

Fundoscopy of Central-involved Diabetic Macular Edema

Central-Involved DME5:

  • Foveal involvement of abnormal intraretinal and/or subretinal fluid
  • Concurrent thickening affecting the 1-mm-diameter central sub­field thickness

AAO = American Academy of Ophthalmology;
ETDRS-DRSS = Early Treatment Diabetic Retinopathy Study–Diabetic Retinopathy Severity Scale;
IRMA = intraretinal microvascular abnormalities.

See More Important Safety Information and Indications
  • CONTRAINDICATIONS: EYLEA® (aflibercept) Injection is contraindicated in patients with ocular or periocular infections, active intraocular inflammation, or known hypersensitivity to aflibercept or to any of the excipients in EYLEA.
Important Safety Information and Indications INDICATIONS

EYLEA® (aflibercept) Injection 2 mg (0.05 mL) is indicated for the treatment of patients with Neovascular (Wet) Age-related Macular Degeneration (AMD), Macular Edema following Retinal Vein Occlusion (RVO), Diabetic Macular Edema (DME), and Diabetic Retinopathy (DR).

Please see the full Prescribing Information for EYLEA.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

The information provided in this site is intended only for healthcare professionals in the United States. The products discussed herein may have different product labeling in different countries.


  1. Early Treatment Diabetic Retinopathy Study Research Group. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Ophthalmology. 1991;98(5 suppl):823-833.
  2. Davis MD, Fisher MR, Gangnon RE, et al; for the Early Treatment Diabetic Retinopathy Study Research Group. Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: Early Treatment Diabetic Retinopathy Study report #18. Invest Ophthalmol Vis Sci. 1998;39(2):233-252.
  3. Staurenghi G, Feltgen N, Arnold JJ, et al. Impact of baseline Diabetic Retinopathy Severity Scale scores on visual outcomes in the VIVID-DME and VISTA-DME studies. Br J Ophthalmol. 2018;102(7):954-958.
  4. American Academy of Ophthalmology. Preferred Practice Pattern®: Diabetic Retinopathy. http://bit.ly/2SX3H2D. Accessed January 14, 2020.
  5. Bakri SJ, Wolfe JD, Regillo CD, Flynn HW Jr, Wykoff CC. Evidence-based guidelines for management of diabetic macular edema. J Vitreoretin Dis. 2019;3(3):145-152.