Understanding the Stages of Diabetic Retinopathy

Diabetic retinopathy is a complication of diabetes that affects the eyes, and its stages can develop in anyone with type 1 or type 2 diabetes.

Diabetic retinopathy is defined as damage to the blood vessels within the retina, the light‑sensitive tissue at the back of the eye. It is generally divided into two main categories: non‑proliferative and proliferative diabetic retinopathy.

However, these two categories can be further broken down into four distinct stages: mild non‑proliferative, moderate non‑proliferative, severe non‑proliferative, and proliferative diabetic retinopathy. The longer you have diabetes and the poorer your blood sugar control, the higher your risk of developing diabetic retinopathy.

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The Four Stages of Diabetic Retinopathy

High blood sugar can cause the tiny blood vessels that nourish the retina to become blocked, gradually cutting off its blood supply. In response, the eye attempts to grow new blood vessels. These abnormal new vessels do not develop properly and may start leaking over time. Each stage of diabetic retinopathy has different warning signs, and each one builds on the previous stage.

Mild Non‑Proliferative Diabetic Retinopathy

This is the earliest stage of diabetic retinopathy and can be difficult to recognize. Symptoms at this point are usually mild, but may include increasing episodes of blurred vision. In this stage, blurriness is caused by tiny bulges that form in the retinal blood vessels.

These bulges are called microaneurysms, and they can lead to leakage from the blood vessels. If you are in this stage, it is crucial to keep your blood sugar under good control and have a comprehensive eye exam every 12 months. Proper blood sugar management can delay the progression of complications.

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Moderate Non‑Proliferative Diabetic Retinopathy

At this stage, visual disturbances become more noticeable, and your visual acuity may start to decline. The retinal blood vessels begin to swell and become distorted, causing structural changes in the retina.

These physical changes can lead to diabetic macular edema (DME). DME develops when fluid starts to accumulate in the central part of the retina—the macula.

The macula is responsible for sharp, central vision. Swelling in this area of the retina directly affects how clearly you see. Patients who reach this stage require more frequent monitoring to preserve their eyesight. An ophthalmologist may recommend eye exams every three to six months.

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Severe Non‑Proliferative Diabetic Retinopathy

This is the third stage of diabetic retinopathy and is also known as pre‑proliferative diabetic retinopathy. In this phase, many of the retinal blood vessels become blocked, significantly reducing the amount of blood reaching the retina.

This impaired blood flow prevents the retina from functioning properly and triggers the release of a protein called VEGF (vascular endothelial growth factor), which stimulates the growth of new blood vessels. At this stage, your vision may worsen, and you may lose the ability to see clearly in low‑light conditions or at night.

You may also notice an increase in floaters or dark spots in your field of vision. Reaching this stage puts you at high risk for permanent vision loss. Treatment becomes necessary to slow further progression and prevent additional loss of sight.

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Proliferative Diabetic Retinopathy (PDR)

This is the most advanced and dangerous stage of diabetic retinopathy. Large areas of the retinal circulation become completely blocked, preventing the retina from receiving the oxygen and nutrients it needs to function. At this point, patients may begin to notice a decrease in peripheral (side) vision.

In response, new blood vessels start to grow on the surface of the retina to compensate for the lack of blood flow. This process is called neovascularization. These new vessels are fragile and can bleed into the gel‑like fluid that fills the eye (the vitreous).

Bleeding into the vitreous is known as a vitreous hemorrhage. It can cause a sudden increase in dark floaters or even a complete loss of vision in the affected eye. In addition, these abnormal vessels can lead to the formation of scar tissue on the retina, which may pull on it and cause a retinal detachment. Both vitreous hemorrhage and retinal detachment can result in severe and sometimes irreversible vision loss.

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Risk Factors for Diabetic Retinopathy

Anyone with type 1 or type 2 diabetes is at risk of developing diabetic retinopathy. This includes individuals who develop diabetes during pregnancy (gestational diabetes). The risk of diabetic retinopathy increases in people who have:

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Whatever eye condition or vision problem you may have, this delicate medical condition requires careful evaluation and appropriate treatment by a skilled, experienced ophthalmologist using effective medical tools that deliver real, positive results. Whatever eye disease you are dealing with, you can book an appointment at Batal Specialized Medical Complex to undergo the necessary examination and begin addressing your eye problems, whatever they may be.

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