Time to Call into Question the Fundus-based Evaluation of Diabetic Retinopathy after Intravitreal Injections

Diabetic retinopathy (DR) scores have two fundamental objectives: (1) detecting DR complications and their severity and (2) predicting the risk of progression to DR complications when they are not yet present. Detecting complications is the easiest part as it only requires to properly evaluate the existing situation such as finding new vessels or an edema. On the contrary, predicting the risk of progression is the most challenging part as it involves predicting the future. Over the last century, the Airlie house classification group and later the Early Treatment Diabetic Retinopathy Study Research (ETDRS) group have done an outstanding work, even with the current standard, to create and improve a scoring to be used to predict the risk of DR progression before the occurrence of complications.[1] Not all diseases and complications can be predicted with the exploration tools available. For example, the occurrence of diabetic macular edema cannot yet be appropriately predicted. Conversely, proliferative DR might be predicted based on the signs seen on fundus examination or, even better, on fundus photos.[1] The ETDRS group has done a very precise stepby- step work, evaluating not only the value of the signs but also the reproducibility of their evaluation, to identify the most suitable signs. Their choices were also based on pragmatism.