Hypertensive retinopathy: a review of existing classification systems and a suggestion for a simplified grading system

Abstract

With the advent of sophisticated ophthalmological investigations and a better understanding of the pathophysiology and clinical or prognostic correlates of the fundal lesions in hypertension, the limitations of early classification schemes using simple ophthalmoscopic appearances are increasingly apparent. This review describes the existing classification systems for hypertensive retinopathy and their limitations, as well as the pathophysiological effects of hypertension on the retinal vasculature. A new and simpler grading system for hypertensive retinopathy is proposed, dividing the features according to prognosis into two categories of non-malignant vs malignant hypertension. Such a simpler, updated system for our medical practice has been long overdue.