The Diabetic Retinopathy Severity Scale (DRSS) is widely used for the classification of both proliferative and nonproliferative diabetic retinopathy. It traces back to the Airlie House classification from the late 1960s. There have been many advances in the diagnosis and management of diabetic retinopathy since then, especially multimodal imaging and anti VEGF medications. This talk will review the advantages, and the disadvantages of the present system. In particular it will describe the shortcomings of the system for classifying patients during the treatment of their retinopathy. Potential considerations for a new classification will be reviewed including especially using modern multimodal imaging.