Diabetic Retinopathy Types and Progression

It is extremely important that all diabetes patients stay up to date on the latest information on diabetic retinopathy. As this disease progresses from the initial stages into more severe stages, devastating symptoms such as retinal detachment and visual impairment begin to occur. Learn more about the progression of the disease, the importance of early diabetic retinopathy diagnosis, and how treatments such as vitrectomy or laser photocoagulation surgery can help slow vision degeneration.

As diabetic retinopathy progresses, vision impairment often occurs gradually; however, sometimes patients experience more sudden changes in vision.

Non-proliferative Retinopathy

The first stage of diabetic retinopathy, known as non- proliferative retinopathy or background retinopathy, often has no noticeable signs or symptoms, although retinal swelling may be present. This is the stage where the tiny capillaries of the retina become semi-permeable membranes. (Later, they will leak fluid and blood.)

The best way to catch background retinopathy before the disease progresses is to schedule regular eye exams with an ophthalmologist. All diabetics, even those who do not require vision correction, should have their eyes thoroughly examined every year. Diabetic women who are pregnant should have their eyes examined every trimester.

Blood glucose control is also a factor in proliferative diabetic retinopathy, macular edema and background retinopathy. Taking care of your eyes goes hand-in-hand with watching your blood sugar. Testing your blood sugar (and testing it often) is imperative for controlling diabetes and preventing vision loss.

Asymptomatic

During the earliest stages, diabetic retinopathy is often asymptomatic. This means that there are no noticeable symptoms - such as pain or vision loss - to the patient, but it is highly possible that an eye specialist might find signs of the disease. For example, retinal swelling may be present, which can only be detected through an eye examination. Get more information on non-proliferative diabetic retinopathy.

Macular Edema

When the center of the macula - the tiny part of the eye responsible for sharp, direct vision - begins to swell, vision may become blurry. This middle stage of diabetic retinopathy, known as macular edema, often overlaps the other stages. This is the stage where the capillaries in the retina begin to leak fluid, causing swelling and blurred vision.

There are two types of macular edema: focal and diffuse. Focal macular edema occurs when the retinal capillaries develop micro-aneurisms which leak fluid, resulting in several distinct points of leakage. Diffuse macular edema is caused by the dilation of retinal capillaries, creating leakage that is diffused over a general area.

The type of macular edema present will determine the kind of diabetic retinopathy treatment your doctor uses. Early detection of macular edema will help ensure the most effective treatment, so diabetics should have their eyes examined every year by a qualified ophthalmologist.

Spotty or Blurry Vision

As the disease advances, minor visual impairment can occur. Although patients are still able to see, they can be frustrated by blurring and blind spots that inhibit clear vision. These symptoms of diabetic retinopathy are sometimes linked to macular edema, which is the swelling of the part of the eye that controls central vision, known as the macula.

Proliferative Diabetic Retinopathy

As damaged blood vessels begin to break, blood can leak into the eye. This third stage of diabetic retinopathy, called proliferative diabetic retinopathy, is characterized by cloudiness and impaired vision. When the retinal capillaries break, they are no longer able to supply the retina with the necessary nutrients. The nutrient-starved retina sends out a chemical signal that prompts the growth of new capillaries. This growth is called neovascularization.

The new blood vessels that form as a result of proliferative diabetic retinopathy cause more damage to the eye. These capillaries are unable to restore nutrients to the retina because they are fragile and weak. They also tend to burst, causing blood and fluid to leak into the eye. The new vessels also exert traction on the surrounding structures and connective tissue, which can eventually detach the retina. Intraocular pressure can also increase as a result of the new capillaries, as they can block the ducts where fluid is drained from the eye. This condition is known as neovascular glaucoma. During proliferative diabetic retinopathy, scar tissue development, retinal detachment, and blindness can occur.

Retinal Detachment

In the final stage of NPDR and the onset of proliferative diabetic retinopathy, severe visual impairment takes place, often accompanied by retinal detachment. Retinal detachment in PDR patients is caused by both the intense swelling (due to abnormal capillaries leaking fluid into the eye) and the traction of scar tissue on the retina itself. If left untreated, retinal detachment causes serious vision loss and even blindness.

Blindness

If the disease has progressed into proliferative diabetic retinopathy without the patient receiving any preventative care or medical intervention, blindness can result. At this time, PDR is the leading cause of new cases of blindness in the United States. Retinal detachment, macular edema, and the breakdown of capillaries in the retina can all prevent normal blood flow through the eye and lead to total vision loss.

Talk to a Doctor

Blood glucose maintenance and regular eye exams are the two most important factors in the successful prevention and treatment of diabetic retinopathy. Whether you are suffering from proliferative diabetic retinopathy, macular edema, or background retinopathy, treatments may be available to help protect your vision and slow the progression of the disease. Diabetics should test their blood sugar daily and be examined by an ophthalmologist annually. Simply search DocShop's directory of qualified ophthalmologists to find a doctor in your area.