RxMx grading system for diabetic retinopathy

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The RxMx grading system for diabetic retinopathy

The images of retinas taken at screening are graded according to national protocol using the RxMx grading system definitions:

R0 = No retinopathy

R1 = Background retinopathy

R2 = Pre-proliferative retinopathy

R3A = Active proliferative retinopathy

R3S = Stable proliferative retinopathy

M0 = No maculopathy

M1 = Maculopathy

A lead clinician in each local screening service determines the final grade and outcome for the patient. The patient is then either returned to annual screening, referred to a digital surveillance clinic for more frequent monitoring or referred to hospital eye services

Referral from screening to digital surveillance clinic

  • Possible results:
    • R2, M1, R3S
  • Follow-up:
    • Screened in surveillance clinic every three, six or 12 months depending on progression of disease

Referral from screening to hospital eye services

  • Possible results:
    • R3A, R2, M1
  • Follow-up:
    • Referred to hospital for diagnosis, possible follow-up tests and treatment. Returned to screening or surveillance after discharge


  • NHS Diabetic Eye Screening Programme - Information for Health Professionals (May 21st 2014).

Last reviewed 11/2020