Diabetic Retinopathy: The Four Stages

foods diabetic retinopathy

Diabetic Retinopathy is damage to the retina from poor blood sugar control. All types of chronic diabetes can cause retinal damage. The retina, at the back of the eye, is neural tissue. Tiny blood vessels, called capillaries, in the retina swell and leak. How often should diabetic patients visit their eye doctors? What are the four stages of diabetic retinopathy?

Eye Care for Diabetes

People medically diagnosed with diabetes should visit their eye doctors every one to two years. The optometrist or ophthalmologist will shine a light into each eye. The doctor will try to detect whether diabetes has compromised the retina. This disease is difficult to diagnose. Therefore, regular exams are crucial.

Symptoms of diabetic retinopathy may not appear until the disease is well-established. The main symptom is blurred vision when glucose levels are high. Vision changes associated with diabetes include:

  • difficulty seeing colors
  • empty or dark areas in vision
  • seeing dark floaters
  • vision loss
  • rapid vision changes

Progressive Stages?

Diabetic retinopathy has four stages. However, it may not progress sequentially through these stages.

Stage 1: Microaneurysms

In its mildest stage, the minuscule capillaries of the retina swell. They begin to leak. This is a non-proliferative form of diabetic retinopathy.

Stage 2: Moderate Non-Proliferative Form

Total blockages occur in some of the capillaries. The retina receives fewer nutrients.

Stage 3: Severe Non-Proliferative Form

In the third stage, the retina is significantly deprived of essential nourishment. The body grows new blood vessels in the damaged areas. “Neovascularization” is a desperate attempt to provide nutrients and blood to the area. However, the new blood vessels are weak. They often leak, causing severe vision loss. White spots that look like tiny strands of cotton and hard exudates (similar to drusen) further pollute the retina.

Stage 4: Advanced Proliferative Form

Neovascularization spreads. Delicate new capillaries appear within and along the surface of the retina. They reach into the vitreous (white) of the eye. The capillaries can alter parts of the retina, distorting vision. Their thin walls mean they are highly likely to leak, leading to vision loss if left untreated.

Summary: Diabetic Retinopathy

In the US, almost half of diabetic patients have diabetic retinopathy in some form. Of the 10% of adults and 25% of seniors who have diabetes, about a third of them do not know it. Regular blood tests at the doctor screen for signs of diabetes. Seniors with diabetes may assume that vision symptoms are a normal part of aging. Having diabetes increases your chances of developing other eye diseases, in addition to diabetic retinopathy. Never become complacent and skip an eye exam. Early detection of eye diseases is essential.


nutrients Up Next: See our page on Diabetic Retinopathy and learn more about Diabetes Mellitus.