National Diabetic Retinopathy Screening Programme
Detecting Retinal Disease
Classifying Diabetic Retinopathy
City & Guilds Units 007 and 008
The on-line tests
These are quite straightforward to arrange. Although the guidance notes say to do the
tasks in order, when I spoke to Clare Waite at C&G in Cheltenham, she didn’t seem to
feel the order mattered much. Personally I (TW) did them as A, C, B, D.
For the on-line tests you need an invigilator and some peace and quiet where you won’t
be interrupted. They are quite happy for the invigilator to be a receptionist. However, the
invigilator will never be allowed to do the C&G grading modules subsequently so choose
carefully! The time allowed for each test is 2 hours. The exam website is at:
www.drscertificate.org
For unit 7 the test consists of 40 images or pairs of images. For some you simply need to
decide if it is gradeable or not. For others, you decide whether there is any retinopathy or
not. On all of them you have to indicate if any referable retinopathy can be seen.
For Unit 8 you need to do full grades on the images presented.
You should definitely do unit 7 before unit 8. Do practice beforehand at:
http://practice.drscertificate.org/exams.asp?Mode=C&C=4&CId=1&LId=6
This will allow you to get used to the 2 sizes available and the red free. The images will
open in a separate window which you can maximise. You don’t need to close it as you
move to the next question as the next image will open in that same window. Be very
careful not to close your main exam window by mistake as this will invalidate your exam.
REMEMBER that the NSC grading criteria are slightly different to ours in that there is no
R1.5 or M0.5. The NSC grades are attached as Appendix 1.
The differences are a bit difficult to quantify but CWS are not R2, they simply prompt a
search for other R2 features. Also the definition of multiple deep, round or blot
haemorrhages is to say the least a bit vague!
Also Our M0.5 grades do not exist in the National scale. They treat “circinate or group
of exudates within the macula” as M1 but other exudates outside 1DD from the
fovea as M0. This similar to our “greater than 1Disc Area in size” criterion but not
quite the same. Once again, the definition of “circinate or group” is very vague!
To arrange an exam, email Laura Prosser at Laura.Prosser@glos.nhs.uk saying that you
are part of the SMDRS programme and wish to arrange an on-line exam for whichever
unit. Give a date and time and the invigilator’s name and email address. She will send
you a user name and logon for the exam and will also send another one to the invigilator.
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Appendix 1: NSC Retinopathy Grading Standard
Retinopathy (R)
Level 0
None
Level 1
Background
microaneurysm(s) retinal haemorrhage(s) ± any exudate not within
the definition of maculopathy
Level 2
Pre-proliferative
venous beading
venous loop or reduplication
intraretinal microvascular abnormality (IRMA)
multiple deep, round or blot haemorrhages
(CWS - careful search for above features)
Level 3
Proliferative
new vessels on disc (NVD)
new vessels elsewhere (NVE)
pre-retinal or vitreous haemorrhage
pre-retinal fibrosis ± tractional retinal detachment
Maculopathy (M)
exudate within 1 disc diameter (DD) of the centre of the fovea
circinate or group of exudates within the macula
retinal thickening within 1DD of the centre of the
fovea (if stereo available)
any microaneurysm or haemorrhage within 1DD of
the centre of the fovea only if associated with a best
VA of ≤ 6/12 (if no stereo)
Photocoagulation (P)
evidence of focal/grid laser to macula
evidence of peripheral scatter laser
Unclassifiable (U)
Unobtainable / ungradable
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