Understanding the Four Stages of Diabetic Retinopathy

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Diabetic retinopathy is the leading cause of vision loss among people with diabetes. Your retina sends messages via your optic nerve to your brain, producing the images you see. With diabetic retinopathy, blood vessels in your retina can become damaged as the result of high blood sugar from diabetes. These blood vessels aren’t able to deliver enough oxygenated blood to your eye. Additionally, these vessels can leak blood and fluids into the retina and may cause your vision to become blurry or cloudy. If the condition continues to advance, it may lead to permanent vision loss. Other symptoms of diabetic retinopathy include “floaters” in your visual field, changes in the ability to see color, difficulty seeing at night, and dark or blank spots in the center of your visual field.

Anyone with diabetes is at risk of developing diabetic retinopathy, but your chances increase the longer you have had diabetes. If you have diabetes, it’s important to understand this progressive condition and its stages because early diagnosis and treatment of diabetic retinopathy can help preserve your sight.

The Stages of Diabetic Retinopathy

There are four stages of diabetic retinopathy. In the early stages of the disease, there may be no changes to your vision.

  1. Mild nonproliferative retinopathy: In the first stage, small dilated pouches called microaneurysms develop in the blood vessels of the retina. They may leak fluid into the tissue.

  2. Moderate nonproliferative retinopathy: Blood vessels in the retina continue to narrow and may even become blocked, interfering with their ability to deliver blood to the retina. The blood vessel walls lose their integrity. This can also cause a build-up of fluid in a part of the retina known as the macula, leading to the development of a condition called diabetic macular edema, in which abnormal blood vessels leak fluid into the eye, causing blurry vision and eventually blindness if untreated.

  3. Severe nonproliferative retinopathy: As the disease progresses, an increasing number of blood vessels in the retina are damaged and blocked. This signals the retina to grow new blood vessels, leading to the next stage of diabetic retinopathy.

  4. Proliferative diabetic retinopathy: In this advanced stage, new abnormal blood vessels are seen within the retina and the vitreous gel, the jelly-like fluid that fills the eyeball. These vessels tend to be fragile, leaking more blood and fluid into the retina and vitreous. Scars and membranes may develop that can cause the retina to tear or detach. Significant vision problems or blindness can occur as a result.

Treating Diabetic Retinopathy

There are several effective treatment options available for diabetic retinopathy, depending on the stage. In earlier stages, you might not need immediate treatment; instead, you’ll check in with your eye doctor regularly to monitor progression. You can also improve your diabetes control by lowering blood sugar levels, eating a healthy diet, and exercising often. When diabetic retinopathy is still in early stages, you can slow the progression by managing your diabetes well.

If you have advanced diabetic retinopathy, you will need treatment right away. Depending on your case, your ophthalmologist may perform laser treatments, intraocular surgery to remove blood and scar tissue from the eye, or you might receive injections into your eye to stop new blood vessels from growing and causing problems.

Can I reduce my risk of developing diabetic retinopathy?

Anyone with diabetes can develop diabetic retinopathy, but there are things you can do to lower your chances and prevent complications. First, be sure to get a yearly dilated eye exam from your ophthalmologist. Regular eye exams allow your ophthalmologist to assess for any signs of damage to your retina and catch diabetic retinopathy in its earliest and most treatable stages.

Keep good control of your blood sugar. You can avoid damage to the blood vessels in your retina by maintaining your blood sugar in a healthy range.

Making healthy lifestyle choices can protect your eyes as well. Quitting smoking decreases your risk of developing diabetic retinopathy. Studies have also shown that controlling your blood pressure and cholesterol lower the risk of vision loss if you have diabetes.

Your vision is precious. Talk to your doctor or ophthalmologist if you notice any changes in your vision or have any questions about diabetic retinopathy.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jun 20
  1. Diabetic
    Retinopathy. American Optometric Association. https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/diabetic-retinopathy
  2. Diabetic
    Retinopathy. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611
  3. Facts About
    Diabetic Eye Disease. National Eye Institute. https://nei.nih.gov/health/diabetic/retinopathy
  4. Top Five Steps to Help
    Prevent Diabetic Eye Diseases. American Academy of Ophthalmology. https://www.aao.org/eye-health/tips-prevention/top-five-diabetes-steps
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