Diabetic Retinopathy Stages - Pictures, Risks and Treatment

Medically Reviewed by Dr. Aman Priya Khanna
Written by Rajath R Prabhu, last updated on 30 December 2022
Diabetic Retinopathy Stages - Pictures, Risks and Treatment

We are all aware of diabetes, as it is a common medical condition today. But did you know that diabetic retinopathy is also the leading cause of blindness in diabetic patients! But what is diabetic retinopathy? This is a complication that arises from long-standing diabetes. The continuously high blood sugar levels damage and weakens the blood vessels in the retina of the eyes. But the good news is that it can be prevented. Before understanding its prevention, we must understand more about the diabetic retinopathy stages. With this, a person with diabetes can look for the warning signs of diabetic retinopathy. 

It can be disturbing to know that diabetes can affect eyesight. That’s why it is crucial to know diabetic retinopathy stages and how to differentiate stages of diabetic retinopathy so that you can consult a doctor the minute you notice these vision changes. Keep reading to understand what are the four stages of diabetic retinopathy, proliferative retinopathy, and what is the treatment for diabetic retinopathy.

What is Diabetic Retinopathy?

Diabetic retinopathy is an eye condition affecting people with diabetes for many years. It causes blurry vision and progresses into loss of sight if blood sugar levels are not well controlled. 

The retina is crucial for vision. It is a light-sensitive tissue at the back of the eye. It is responsible for sending signals to the brain, allowing one to see. 

The elevated blood sugar levels damage blood vessels in the retina and cause fluid to leak, causing swelling. The fluid collection and swelling cause blurry vision and reduce the retina's oxygen supply. Due to this, new blood vessels are developed by the body to improve the oxygen supply. This is also called proliferative retinopathy. The new blood vessels can break easily and cause bleeding, worsening vision and blindness.

With timely care and complete treatment, the progression of diabetic retinopathy stages can be prevented. For its prevention, a person with diabetes must know about the proliferative diabetic retinopathy symptoms.
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What are the Stages of Diabetic Retinopathy?

There are two types of diabetic retinopathy stages, which include non-proliferative and proliferative diabetic retinopathy. Non-proliferative diabetic retinopathy (NPDR) is the early stage of diabetic retinopathy when new blood vessels haven’t yet formed in the retina. Proliferative diabetic retinopathy (PDR) is the advanced stage of diabetic retinopathy. 

Below are different diabetic retinopathy stages:

  1. Stage 1: Mild non-proliferative diabetic retinopathy
  2. Stage 2: Moderate non-proliferative diabetic retinopathy
  3. Stage 3: Severe non-proliferative diabetic retinopathy
  4. Stage 4: Proliferative diabetic retinopathy

The progression of diabetic retinopathy can be described via the diabetic retinopathy stages. The four diabetic retinopathy stages are as follows:

Stage 1: Mild non-proliferative diabetic retinopathy  

  1. This is the earliest stage of diabetic retinopathy. 
  2. It is also called background diabetic retinopathy. 
  3. This stage is characterised by small bulges or swelling in the retinal blood vessels, known as ‘microaneurysms’.
  4. Microaneurysms occur due to high blood sugar levels that may further rupture and bleed, resulting in bleeding in the retina. 
  5. At this stage, a person may not notice any changes in their vision. However, the signs of early stages can be detected during an annual eye examination. 
  6. An eye doctor can identify the stage and guide regarding keeping the blood sugar, cholesterol, and blood pressure in control to prevent disease progression.

Stage 2: Moderate non-proliferative diabetic retinopathy 

  1. This is also called pre-proliferative retinopathy. 
  2. In this stage, the retina’s blood vessels start to swell, block blood flow, and impact blood circulation in the retina. 
  3. A person may also notice mild visual symptoms due to diabetic macular oedema (DME). DME affects most individuals with diabetic retinopathy. 
  4. If blood leaks from the blood vessels into the macula (centre of the retina), it may cause swelling leading to loss of vision for fine details and vision in the centre of the eye. 
  5. If a person is diagnosed with moderate NPDR, they should have a follow-up eye examination every three to six months to assess progression.

Stage 3: Severe non-proliferative diabetic retinopathy 

  1. In this stage, a large part of blood vessels becomes blocked, resulting in decreased blood supply to the retina. Insufficient blood supply signals the body to make new blood vessels in the retina. 
  2. A person may notice blurry vision and dark spots (floaters) due to completely blocked blood vessels. This is called macular ischemia. 
  3. In this stage, the risk of blindness is high; however, there are treatments to prevent further loss of vision if pursued immediately. 
  4. A person diagnosed with severe NPDR is advised to have a follow-up examination every three to six months. [3,4]

Stage 4: Proliferative diabetic retinopathy 

  1. This is the most severe and last stage of diabetic retinopathy. 
  2. In this stage, the formation of new blood vessels occurs, which are thin and weak and can break easily. This may cause bleeding in the vitreous (gel-like fluid in the eye) and cause sudden severe vision difficulties, retinal scarring, and blindness. 
  3. A complication called retinal detachment can occur at this stage if the scar tissue in the retina shrinks and pulls the retina away from the back of the eye. 
  4. This can result in permanent peripheral and central vision loss. A person diagnosed with PDR is recommended to follow up every month to stabilise the condition.

Difference between the 4 Stages of Diabetic Retinopathy

The difference between diabetic retinopathy stages is described in the following table:

Diabetic Retinopathy 



Causes Treatment
Normal or Mild Nonproliferative Retinopathy

No symptoms

The blood vessels in the retina are damaged by high blood sugar levels

Control blood sugar levels

Moderate Nonproliferative Retinopathy

No symptoms

Blood vessels in the retina are blocked, leading to decreased blood flow

Control blood sugar levels, laser treatment to seal off blocked blood vessels

Severe Nonproliferative Retinopathy

No symptoms

Decreased blood flow to the retina causes death of retinal tissue and growth of new, weaker blood vessels

Control blood sugar levels, laser treatment to seal off blocked blood vessels

Proliferative Retinopathy
  1. Blurred vision
  2. Floaters
  3. Dark spots
  4. Seeing faded colour 
  5. Seeing flashes of light

Severe damage to the retina causes the growth of new, abnormal blood vessels on the surface of the retina and inside the eye.

Control blood sugar levels, laser treatment to destroy abnormal blood vessels, injections of medications to stop the growth of new blood vessels

It's important to understand that diabetic retinopathy symptoms may not show until the disease has evolved to its advanced stages. Regular eye exams and blood sugar level monitoring are important for the early detection and treatment of the condition.

How to Diagnose Diabetic Retinopathy?

Diabetic retinopathy is typically diagnosed through a comprehensive eye exam, including:

  1. Dilated eye exam
  2. Visual acuity test
  3. Imaging tests such as fundus photography or optical coherence tomography. 

Your doctor may also check for signs of other related eye problems, such as cataracts or glaucoma. Diabetic patients must undergo regular eye check-ups to detect and manage diabetic retinopathy early.

How is Diabetic Retinopathy Treated?

For the treatment of diabetic retinopathy, the doctor will consider several factors when creating a treatment plan, including:

  1. Medical history
  2. Age
  3. Visual acuity
  4. The extent of retinal damage

Haemoglobin A1c (HgbA1c) for an average blood glucose level of two to three months. 

In the initial diabetic retinopathy stages, the doctor may use a wait-and-see approach. The patient will be informed to have regular eye examinations but does not need further treatment. Some patients may require an eye examination every two to four months. Other treatment options include:

  1. Injections: The eye surgeon may inject medications (corticosteroids or anti-vascular endothelial growth factor drugs) to slow the progression of diabetic retinopathy and improve vision. 
  2. Vitrectomy: The doctor may advise this eye surgery if a person has cloudy vision because of the leaking blood vessels. During this surgery, the eye surgeon makes a small cut in the eye and removes the scar tissues. 
  3. Laser Surgery: The eye surgeon uses a laser to reduce the swelling in the retina and the growth of new blood vessels. The laser shrinks the blood vessels or stops their leakage.

When to Seek Medical Help?

At the beginning of diabetic retinopathy stages, a person may not notice any signs. However, if a person with diabetes sees the following changes, they must immediately seek medical help:

  1. Blurred vision
  2. Black spots 
  3. Flashes of light

If a person has diabetes, they must have an eye examination at least once a year. Pregnant women with diabetes should schedule their eye examination during the first trimester. 


Diabetic retinopathy is a common condition in diabetes patients. If you do not monitor and manage your blood sugar levels, complications like diabetic retinopathy may occur in the long run. Now you know the diabetic retinopathy stages and how they progress. If the condition advances, you may need surgery. So prevention is the key!

We understand this might be worrying, but this should encourage you to have regular eye check-ups. HexaHealth is here to help you prevent damage to your vision.  If you have any questions or are noticing the symptoms discussed above, you can get in touch with the personal care team. They will guide you and answer all your questions. You can also visit our website Hexahealth to learn more about diabetic retinopathy stages, prevention, treatment, etc.

Frequently Asked Questions

What is the most severe diabetic retinopathy?

The most severe diabetic retinopathy is proliferative diabetic retinopathy (PDR). It is the last of the four stages of diabetic retinopathy. The growth of abnormal fragile blood vessels occurs over the retina and causes retinal scarring and vision difficulties and can even lead to blindness.

How do you stop diabetic retinopathy from progressing?

You can prevent diabetic retinopathy from progressing by managing blood sugar, cholesterol, and blood pressure. You must also understand the different diabetic retinopathy stages to know the signs and symptoms of your condition progresses.

What is the best treatment for diabetic retinopathy?

The best treatments for diabetic retinopathy are managing blood sugar, cholesterol, and blood pressure, followed by laser surgery, injecting medications into the eye, or vitrectomy in severe cases.

What foods are good for retinopathy?

Foods such as citrus fruits, beans, green leafy vegetables, berries, and fish high in omega-3 fatty acids, whole grains, nuts, milk, yoghurt, etc., are rich in antioxidants, minerals, vitamins, and fibre and are considered good for diabetes. Consuming these regularly will prevent diabetes from worsening and prevent retinopathy.

What are the best eye drops for diabetic retinopathy?

Do not self-medicate. Always consult an eye doctor (ophthalmologist) before using any eye drops for diabetic retinopathy. 

What vitamins are good for diabetic retinopathy?

Vitamins B, C, D and E are helpful for diabetic retinopathy. Therefore, a person with diabetes must involve fruits and vegetables rich in vitamins B and D in their diet. 

Is there a pill for diabetic retinopathy?

Do not consume any medicine for diabetic retinopathy without consulting your diabetologist. You must take expert advice before consuming any medications. 

Do eye injections work for diabetic retinopathy?

Yes, eye injection is one of the treatment options for diabetic retinopathy in which medications like corticosteroids or anti-vascular endothelial growth factor are injected into the eye to improve vision and slow disease progression.

Can diabetic retinopathy get better?

The condition of diabetic retinopathy can improve when it is still in the early stages by managing well blood sugar, blood pressure, and cholesterol levels. 

Is there surgery for diabetic retinopathy?

Laser surgery and vitrectomy are surgeries performed to treat diabetic retinopathy.

How do people live with diabetic retinopathy?

In the early stages of diabetic retinopathy, there are no symptoms. However, detecting it in the early stages can be helpful. For this reason, a person with diabetes must undergo an eye examination every year.

What is the first-line treatment for diabetic retinopathy?

The first line of treatment for diabetic retinopathy involves prevention. A diabetic patient must regularly monitor and manage their blood pressure, blood sugar, and cholesterol levels. They should have eye check-ups at least once a year. 

Is laser surgery for diabetic retinopathy painful?

Laser surgery for diabetic retinopathy is not painful as numbing drops are instilled in the eyes before the surgery. However, you may feel a mild pricking or tingling sensation in your eye during the laser surgery.

Can diabetic retinopathy be reversed?

There is no cure for diabetic retinopathy. Fortunately, the onset and progression can be prevented and treated. For prevention, a person with diabetes should manage their cholesterol, blood pressure, and blood sugar level. Treatment of diabetic retinopathy involves laser surgery, injections, and vitrectomy.

Updated on : 30 December 2022


Dr. Aman Priya Khanna

Dr. Aman Priya Khanna

MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES

12 Years Experience

Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More


Rajath R Prabhu

Rajath R Prabhu

MSc. Clinical Research I PG Diploma in Public Health Services Management

3 Years Experience

His work in medical content writing and proofreading is noteworthy. He has also contributed immensely to public health research and has authored four scientific manuscripts in international journals. He was assoc...View More

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