Diabetic Retinopathy Stages - Pictures, Risks and Treatment

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.

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.

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

Diabetic Retinopathy  Stages	Symptoms	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	Blurred vision Floaters Dark spots Seeing faded colour  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.

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.

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.

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.