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Diabetic Retinopathy: What Are the Different Types and Stages?

Diabetic Retinopathy: What Are the Different Types and Stages?

Several people suffer from diabetes, but aside from the condition alone, it may also lead to further complications. Among them is how it could eventually affect one’s vision. Read on to know more about the types and stages of diabetic retinopathy.

Diabetic Retinopathy, Explained

As the name suggests, diabetic retinopathy refers to an eye condition due to diabetes. This complication weakens the blood vessels in the retina (thin light-sensitive tissue layer in the back of your eyes).

Most people have no symptoms of diabetic retinopathy in the early phases. You may not notice any changes in your vision until the condition worsens. Symptoms may appear and disappear for some people. Some of the notable symptoms include:

  • Eye floaters (small dark spots or streaks in vision)
  • Blurred vision
  • Eye pain or redness
  • Night blindness
  • Difficulty in reading or seeing things from afar
  • Gradually worsening vision
  • Sudden vision loss

Diabetic retinopathy is more likely to develop as your diabetes progresses over time. This, in turn, affects both eyes.

When you have high blood sugar levels for an extended period of time, fluid can build up in the lens inside the eye, which controls focusing. This alters the curvature of the lens, resulting in vision changes. But, when blood sugar levels are under control, the lens will usually return to its original shape. Hence, improving your vision. Those who can better control their blood glucose levels will have a slower onset and progression of the eye condition.

Types of Diabetic Retinopathy

Similar to any other disease, diabetic retinopathy also has some particular types.

Nonproliferative diabetic retinopathy (NPDR)

This type refers to the early disease stage wherein blood vessels swell and leak. It may appear as a fluid, hemorrhage, or lipid in the retina. These blood vessels eventually close, resulting in ischemia, or low blood flow. In some cases, it can also lead to macular edema (retinal swelling), which can lead to mild vision loss.

Proliferative diabetic retinopathy (PDR)

As the disease advances, the abnormal blood vessels tend to develop as a reaction to ischemia. These vessels can rupture and leak into the clear watery gel, which fills the eye. Thus, resulting in severe vision loss.

A person with this condition may also have other serious eye conditions like diabetic macular edema and neovascular glaucoma.

Stages of Diabetic Retinopathy

Diabetic retinopathy is an eye condition that can manifest f in different stages as it progresses. Your eye doctor may conduct several tests with a complete health history and eye exam to diagnose it. A visual acuity test is a common eye chart test measuring the central vision ability at different distances.

Stage 1: Background Retinopathy

In this stage, there are tiny bulges (microaneurysms) that have formed in the blood vessels of the retina. This then allows small amounts of blood to leak, which is quite common to people with diabetes.

During this stage:

  • Vision remains fine and still is unaffected. However, you are more likely to develop vision problems in the near future.
  • There are no necessary treatments that should take place, but you must take precautions to keep the problem from worsening.
  • Vision may greatly deteriorate when both eyes are affected.

Stage 2: Pre-proliferative Retinopathy

The second stage puts your eyes, particularly your retina, to severe and widespread changes. Bleeding into the retina may also take place.

At this stage:

  • There is a high possibility that your vision will be affected in the future.
  • You may need more frequent screening appointments every 3, 6, 9, or 12 months to monitor the progression of the condition.

Stage 3: Proliferative Retinopathy

Upon reaching the third stage, there is the formation of new blood vessels and scar tissues on the retina. Thus, causing massive bleeding which may lead to retinal detachment. This is a condition wherein the retina pulls away from the back of the eye.

At this stage:

  • There is a strong possibility that you could lose your vision.
  • You already need the help of treatments to sustain your vision as much as possible. However, it will not be able to restore your old vision.

Diabetic Maculopathy

There are those instances wherein the blood vessels in the central part of the retina (macula) could become leaky or blocked.

If the doctor discovers this in your eyes:

  • There is a high possibility that your vision will be adversely affected in the future.
  • You might also need to undergo several more frequent specialized testing to monitor your eyes.
  • Your doctor may discuss all the possible treatment options to prevent the condition from worsening.

Treatment for Diabetic Retinopathy

The treatment for diabetic retinopathy varies according to the severity of the disease. Some may require laser surgery to seal leaking blood vessels or to prevent other blood vessels from leaking. An optometrist may also need to inject medications into the eye to reduce the inflammation or stop the formation of new blood vessels. But those with advanced type may need more than these two common treatments. They may undergo a surgical operation, such as a vitrectomy, to remove and replace the vitreous, gel-like fluid in the retina. A retinal detachment may also demand eye surgery.

If you have diabetes, you can help minimize or slow down the progression of diabetic retinopathy by doing the following:

  • Taking your prescribed medication
  • Maintaining your diet
  • Exercising regularly
  • Managing high blood pressure
  • Avoiding alcohol and smoking

Key Takeaways

Although preventing diabetic retinopathy can be difficult, there are still ways to reduce the chances of it worsening.

Getting a diabetic eye exam at least once a year and following your diabetes management plan are helpful steps to keep things at bay.

Learn more about Diabetic Complications here.

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Written by Fiel Tugade Updated Apr 05
Medically reviewed by Dexter Macalintal, MD