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Diabetic retinopathy is a diabetes-related complication that generally affects the eyes, predominantly the retina. It has various levels of severity marked by changes in the vessels of the retina that tend to cause vision loss and, if not treated appropriately, can lead to dire consequences. The earlier in its stages that diabetic retinopathy is diagnosed, the better the outcome is likely to be. This blog addresses all stages of diabetic retinopathy, its causes and symptoms, and treatment methods.
Synopsis
What is Diabetic Retinopathy?
Diabetic retinopathy is a condition where high blood sugar, caused by diabetes, damages the small blood vessels within the retina. The retina is a part of the eye that collects light signals to be translated to the brain. There are various stages of diabetic retinopathy, ranging from mild to severe conditions.
When diabetic retinopathy advances, these little blood vessels swell and leak or become thoroughly blocked which may cause some damage to vision. The potential danger could lead to extreme loss of vision, up to eventual blindness. Diabetic retinopathy symptoms often appear when the condition is advanced in the later stages. Yearly dilated eye exams, including optical coherence tomography (OCT), and/or fluorescein angiography, for long-standing diabetes patients are important for early detection and intervention.
What Causes Diabetic Retinopathy?
Chronic high blood glucose caused by Type 1 and Type 2 diabetes is the primary cause of diabetic retinopathy. Constant high blood sugar levels damage the tiny vessels of the retina, causing an inappropriate supply of blood and nutrition to this sensitive area.
Other risk factors of diabetic retinopathy include:
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High blood pressure (hypertension)
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Cholesterol
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Smoking
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Sedentary lifestyle
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Poor dietary choices
Diabetic Retinopathy and Diabetes Mellitus (DM)
Long-standing diabetes plays a major role in increasing the risk of diabetic retinopathy. Over time, high blood sugar damages blood vessels in the retina, potentially leading to vision impairment or blindness. A World Health Organization study found that diabetic retinopathy is one of the leading causes of vision impairment globally. However, with proper diabetes care, early-stage diabetic retinopathy may be diagnosed and treated before its progression.
Long-term diabetes can also cause cataracts and glaucoma, which are more common in diabetic patients. People with diabetes are twice as likely to develop cataracts and glaucoma than people with no history of diabetes.
Read the blog: Managing Type 2 Diabetes with Diet and Exercise
Diabetic Retinopathy and Hypertension: Impact on Eye Health
Both diabetes and hypertension can cause retinopathy by causing injury to the blood vessels in the retina. With high blood pressure, pressure increases in the vessels – this can lead to sudden eye bleeding, which may result in vision loss. High BP can block large and small retinal vessels, damaging the optic nerve and causing long-term vision disturbances.
Managing these risks and controlling diabetes and hypertension can help maintain vision and prevent complications.
Stages of Diabetic Retinopathy
Diabetic retinopathy is classified broadly into two main stages:
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Non-Proliferative Diabetic Retinopathy (NPDR)
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Proliferative Diabetic Retinopathy (PDR)
These 2 diabetic retinopathy stages are further categorized based on the severity and progression of the condition. Below are the stages of diabetic retinopathy:
Stage 1: Non-Proliferative Diabetic Retinopathy (NPDR)
NPDR is the early stage of diabetic retinopathy. In this stage, the blood vessels in the retina become weak and may leak fluid or blood. In the early stages of NPDR, symptoms may be minimal or nonexistent. For more advanced non-proliferative diabetic retinopathy, symptoms may include blurred vision or dark spots.
This stage is categorized into four levels based on the extent of blood vessel damage and changes in the retina:
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No Diabetic Retinopathy (DR): No signs of retinopathy are detected in this stage, but regular annual eye check-ups (every 12 months) are recommended.
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Very Mild Non-Proliferative Diabetic Retinopathy (NPDR): At this stage, microaneurysms (tiny bulges in the blood vessels) may develop in the blood vessels in the retina. These may leak small amounts of blood or fluid. Most patients can be reviewed annually during mild NPDR.
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Mild Non-Proliferative Diabetic Retinopathy (NPDR): Along with microaneurysms, there may also be small retinal haemorrhages (bleeding), exudates (protein or fat deposits), or cotton-wool spots (tiny, pale patches on the retina). Patients are reviewed every 6–12 months depending on individual health factors and disease stability.
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Moderate Non-Proliferative Diabetic Retinopathy (NPDR): The retina shows signs of worsening damage, like severe retinal haemorrhages or mild intraretinal microvascular abnormalities (IRMA). Venous beading or cotton wool spots are also present. For these patients, review is usually advised every 6 months as up to 26% of diabetic retinopathy patients at this stage may progress to Proliferative Diabetic Retinopathy within a year.
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Severe and More Severe NPDR: More severe symptoms of diabetic retinopathy include haemorrhages across multiple areas of the retina, venous beading in several regions, and moderate IRMA. In very severe cases, two or more of these symptoms are prominently seen. Review is required every 2-4 months, as up to 45% - 50% may advance to high-risk PDR within a year.
Non-Proliferative Diabetic Retinopathy Treatment
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Close monitoring and control of blood sugar can often halt the progression of the disease.
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Changes in lifestyle, medication, diet, and exercise are the major weapons in controlling diabetes.
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Additional advice may also include routine eye check-ups and laser therapy in severe cases by a top ophthalmologist in Malleshwaram.
Stage 2: Proliferative Diabetic Retinopathy (PDR)
This is the most advanced stage, where abnormal new blood vessels grow along the retina and into the eye's vitreous gel (the gel inside the eye). This is due to a lack of oxygen supply to the retinal tissue. These new vessels are fragile and prone to leaking, which can cause severe vision loss. Fibrous tissue may also form, leading to retinal detachment and potential blindness. The symptoms of advanced diabetic retinopathy include significant vision loss, dark spots, floaters, and, in some cases, sudden vision loss.
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Mild - Moderate Proliferative Diabetic Retinopathy (PDR): New blood vessels can appear in the retina but remain below the high-risk threshold. Patients are reviewed every 2 months unless treatment is needed.
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High-Risk Proliferative Diabetic Retinopathy (PDR): New vessels around the optic disc or retina may lead to severe haemorrhages – this increases the risk of retinal detachment and vision loss.
Proliferative Diabetic Retinopathy Treatment
Treatment should begin immediately when possible and certainly on the same day if the patient presents with a symptomatic presentation with a good retinal view.
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Laser therapy or vitrectomy surgery (removing the vitreous gel to prevent further bleeding) is often recommended as the ideal diabetic retinopathy treatment at this stage.
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Medications such as anti-VEGF injections also help in the reduction of new blood vessel growth and minimize swelling.
Our top ophthalmologists in Bangalore can recommend the best possible treatment option for a patient based on their stage of progression and other health factors.
Preventing Diabetic Retinopathy
Prevention strategies for diabetic retinopathy mainly focus on keeping blood sugar levels in the acceptable range, managing blood pressure and cholesterol, and avoiding smoking. Regular eye exams, once a year, for those with long-standing diabetes, can be beneficial in early detection to improve treatment outcomes significantly. Individuals with diabetes should also work closely with their doctors to monitor and manage their condition. Further, knowing diabetic retinopathy stages can help individuals recognize early signs and take preventive steps to protect their vision.
If you or someone you know has diabetes, consult a top eye specialist in Bangalore for diabetic retinopathy screening and maintain eye health.
FAQ's
The main 2 stages of diabetic retinopathy are:
- Mild non-proliferative diabetic retinopathy
- Proliferative diabetic retinopathy
Each diabetic retinopathy stage indicates progressively worsening damage to the blood vessels in the retina.
In patients with early-stage diabetic retinopathy, there may not be any noticeable symptoms that can be reported to your doctor. Therefore, you must undergo eye exams once a year so that the condition, if develops, can be detected in its earliest stage.
Strict blood sugar control and treatment can manage and slow the disease in its early stages, but advanced stages often require specialized medical procedures, as the damage can be irreversible.
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