Diabetic Macular Oedema (DMO) Classification
Diabetic macular oedema (DMO) classified on examination / OCT as absent, non-centre-involving or centre-involving (ICO 2017), with centre-involving DMO split by visual acuity (DRCR Protocol V). Drives observation, anti-VEGF and laser decisions.
Score interpretation
No retinal thickening or hard exudates in the macula (ICO 2017).
→ Routine screening interval per DR grade. Optimise HbA1c, BP, lipids.
Retinal thickening in the macula that does not involve the central 1 mm subfield (ICO 2017).
→ Hospital eye service referral; monitor with OCT (ICO: re-examine in about 3 months). Focal/grid laser if exudate or thickening threatens the fovea (ETDRS).
Central 1 mm subfield involved with visual acuity 6/7.5 (20/25) or better.
→ Observation with close follow-up is an acceptable initial strategy (DRCR Retina Network Protocol V, JAMA 2019); start anti-VEGF if vision drops or thickening increases.
Central 1 mm subfield involved with visual acuity worse than 6/7.5.
→ Intravitreal anti-VEGF (ranibizumab, aflibercept, faricimab) per NICE TA274/TA346/TA799 when the central retinal thickness is 400 µm or more at the start. Adults: loading 4–6 monthly injections then PRN/T&E. Children: use a children's formulary. Dexamethasone implant (Ozurdex; NICE TA824) if non-corticosteroid therapy has not worked well enough or is unsuitable. Consider focal laser for refractory non-centre fluid.
Interpretation bands for the DMO. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Ranibizumab · Anti-VEGF (intravitreal injection)
- Bevacizumab (Intravitreal) · Anti-VEGF (Vascular Endothelial Growth Factor Inhibitor)
- Aflibercept 2mg/0.05mL Intravitreal Injection (Eylea) · Anti-VEGF agent (intravitreal)
- Faricimab (Intravitreal) · Anti-VEGF and Anti-Ang-2 — Bispecific Monoclonal Antibody
- Brolucizumab (Intravitreal) · Anti-VEGF — Single-chain Antibody Fragment (scFv)
- Pegaptanib Sodium · Anti-VEGF (RNA Aptamer) — Neovascular AMD
- Acute Red Eye / Vision Loss Screen · RCOphth 2020; NICE CKS
- Idiopathic Intracranial Hypertension · ABN; consensus 2018
- Acute Red Eye Assessment · RCOphth / AAO
- Acute Angle Closure Glaucoma · RCOphth / EGS Guidelines
- Retinal Detachment · RCOphth Guidelines / EURETINA
- Diabetic Retinopathy — Screening and Management · NICE NG28 2016 / NHS DES Programme
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.