Hypertensive Retinopathy - Keith Wagener Barker (KWB) Grades

Keith Wagener Barker (KWB) Grades

Grade 1

Generalised arteriolar constriction - seen as `silver wiring` and vascular tortuosities.

Grade 2

As grade 1 + irregularly located, tight constrictions - Known as `(AV) nicking` or `AV nipping`

Grade 3

As grade 2 + with cotton wool spots and flame-hemorrhages

Grade 4

As above but with swelling of the optic disk (papilledema)

There is an association between the grade of retinopathy and mortality. In a classic study in 1939 Keith and colleagues described the prognosis of people with differing severity of retinopathy. They showed 70% of those with grade 1 retinopathy were alive after 3 years whereas only 6% of those with grade 4 survived.The most widely used modern classification system bears their name. The role of retinopathy grading in risk stratification is debated, but it has been proposed that individuals with signs of hypertensive retinopathy signs, especially retinal hemorrhages, microaneurysms and cotton-wool spots, should be assessed carefully.