The COMS Grading Scheme: Graded Features
Hard exudates (lipid)
Hard exudates are small white or yellowish white deposits with sharp margins. Often, they appear waxy, shiny, or glistening. They are located in the outer layers of the retina, deep to the retinal vessels. They can be arranged as individual dots, confluent patches, sheets, or in rings or crescents surrounding zones of retinal edema or groups of microaneurysms. Exudates are occasionally deposited along retinal veins. On angiography, small dots are not visible, but larger patches may block choroidal fluorescence. Exudates are differentiated from drusen which hyperfluoresce during the transit phase and become less prominent in late phases. Microaneurysms that appear as white dots with no blood visible in the lumen are considered hard exudates.
Severity
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| None: not present |
Mild: total area less than 1/4 disc area (standard photograph 1)
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Moderate: total area more than 1/4 disc area, but less than 1 disc area (standard photograph 2)
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| Severe: total area more than 1 disc area |
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