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Diabetic retinopathy: Types and stages

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Diabetic retinopathy (DR) is an eye condition that can affect people with both Type-1 and Type-2 diabetes, causing increased eye pressure and blood glucose levels in the blood vessels of the eye. 

The condition has four stages of progression: 

  • Mild nonproliferative diabetic retinopathy

  • Moderate nonproliferative diabetic retinopathy

  • Severe nonproliferative diabetic retinopathy

  • Proliferative diabetic retinopathy

“Proliferative” means there is abnormal blood vessel growth (neovascularization) in the retina, while “nonproliferative” indicates the opposite. 

Each stage of diabetic retinopathy can contribute to the risk of further vision problems and conditions, including diabetic macular edema (DME), glaucoma and even blindness.

Mild nonproliferative retinopathy: early stage of DR

The earliest stage of diabetic retinopathy is the mild nonproliferative stage. During this stage, the presence of diabetes can cause the structure of the retina to change. At least one microaneurysm (a tiny red protrusion, or “bulb,” in a blood vessel in the retina) occurs during this stage.

Moderate nonproliferative retinopathy: mid-stage of DR

Blood vessels, which nourish the retina, are at risk of swelling and becoming blocked during the moderate nonproliferative stage of DR. Hemorrhages, microaneurysms and white spots called “cotton wool spots” also occur during this stage of DR. 

What can happen during the moderate nonproliferative retinopathy stage of DR?

  • Diabetic macular edema (DME)

  • Blood vessels in the retina may swell and/or become blocked

  • Hemorrhages, microaneurysms

Severe nonproliferative retinopathy: mid-stage of DR

Blood vessels become increasingly blocked in the eye during the severe nonproliferative stage of DR. When this happens, the retina is unable to receive blood that it needs to function and is signaled by proteins called vascular endothelial growth factors (VEGFs) to grow new (but abnormal) blood vessels. Microaneurysms and hemorrhages occur during this stage of DR. 

What can happen in the severe nonproliferative retinopathy stage of DR?

  • New blood vessels grow in the retina

  • Diabetic macular edema (DME)

  • Hemorrhages, microaneurysms

Proliferative diabetic retinopathy: the final stage of DR

Proliferative diabetic retinopathy is the final, most advanced stage of diabetic retinopathy. During this stage of DR, new blood cells can increase in the retina and make their way into the vitreous (the gel-like substance that fills the eye). These blood vessels are delicate and can eventually lead to retinal detachment.

What can happen during the proliferative diabetic retinopathy stage of DR?

  • Diabetic macular edema (DME)

  • Retinal detachment

  • Complications from retinal detachment, such as flashes of light, spotty vision and vision loss

Can diabetic retinopathy be reversed?

Surgery, injections and other treatments for diabetic retinopathy may help patients cope with various stages of the condition, but there is currently no cure. Regular eye exams, as well as specialized diabetic eye exams, can help catch the condition early so adequate treatment can begin as soon as possible.

Since diabetes is a life-long disease, it is crucial that it is treated with proper diet, exercise, medicine and other medical needs — including vision care, as diabetic retinopathy is only one type of potential diabetic eye problem.

SEE RELATED: Diabetic eye disease: What’s your risk?

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Brian Boxer Wachler

Brian Boxer Wachler, MD, is an ophthalmologist and refractive surgeon at the Boxer Wachler Vision Institute in Beverly Hills, Calif. He has pioneered treatments for keratoconus, participated ... Read more