Examination of the optic fundi is also important in defining the severity and chronicity of hypertension. Our patient's left optic fundus is shown. The severity of the changes seen is mild to moderate. This is reflected by arteriolar narrowing and focal arteriolar spasm. Chronicity is reflected by significant AV nicking, and is not directly related to the degree of hypertension or prognosis. His right optic fundus showed similar changes.
Retinopathy classification
The Keith-Wagener-Barker grading system for assessing hypertensive retinopathy is presented for your review. The increasingly severe changes are directly related to the prognosis. Our patient has grade II hypertensive retinopathy. The classification for arteriosclerotic retinopathy is different.
Grade IV retinopathy
This fundus from another patient shows papilledema, flame-shaped hemorrhages, cotton wool exudates and generalized arteriolar spasm reflecting a grade IV hypertensive retinopathy.