Leishman developed a classification system for identifying groups of patients with hypertensive retinopathy. This stresses the fact that arteriosclerosis may occur as part of the natural aging process and affects how the arterioles respond to hypertension.
|
Arterioles |
Arteriovenous Crossing |
Retina |
Group |
|
straight and narrow |
no changes |
age changes in fundus |
1 (involutional sclerosis) |
|
segments near disc dilated; distal segments narrow |
may be present |
age changes in fundus |
2 (involutional sclerosis with hypertension) |
|
major arterioles dilated, others narrow |
present |
age changes in fundus |
3 (advanced involutional sclerosis with hypertension) |
|
normal |
no changes |
normal fundus |
4 (normal fundus of youth) |
|
diffuse constriction |
may be present |
normal fundus |
5 (early hypertension n youthful vessels) |
|
diffuse constriction |
veins hidden at crossing |
papilledema and retinal edema; retinal hemorrhages |
6 (fulminating hypertension) |
|
changes of groups 2 and 5 |
may be present |
|
7 (severe hypertension with relative sclerosis) |
where:
• In arteriosclerosis the vessels show enhanced light reflection, focal attenuation and irregular caliber.
• Groups 1 to 3 seem to refer to the older patient with arteriosclerosis, while 4 to 6 apply mostly to the patient with hypertension without arteriosclerosis.
Purpose: To evaluate the retinal changes in a patient with hypertension using the classification of Leishman.
Specialty: Ophthalmology, Cardiology
Objective: criteria for diagnosis, severity, prognosis, stage, differential diagnosis and mimics, red flags
ICD-10: H35.0, I70.9,
