Non-Proliferative Diabetic Retinopathy

Problems of diabetes and eyes begin as early as a few weeks of the beginning of diabetes. Since diabetes leads to rise in blood sugar levels and as blood travels in blood vessels, most damage is done to blood vessels.

What happens in non-proliferative diabetic retinopathy?

It is the first in diabetic retinopathy stages and is also known as background diabetic retinopathy. Diabetic retinopathy is a progressive illness of small blood vessels and nerves of the retina. High blood sugar levels and toxic amounts of sorbitol in the blood vessels lead to progressive decay and death of cells. This leads to non-proliferative diabetic retinopathy.

Non-proliferative diabetic retinopathy does not cause any vision changes and does not manifest in the form of symptoms. It is only visualized in diagnostic tests like fundus photography or Fluorescein angiography. In this early stage, the walls of retinal blood vessels are damaged. This leads to pouches that protrude out of them. These pouches are called microaneurysms.

In a fundus examination if:

  • A person has early or mild non-proliferative diabetic retinopathy when there is at least one microaneurysm.
  • A person has moderate non-proliferative diabetic retinopathy if there are multiple microaneurysms along with dot and blot hemorrhages, cotton wool spots and venous beading.
1.       Dot and blot hemorrhages: Accumulation of blood and fluid in the retina. These are classic symptoms of diabetic retinopathy.

2.      Cotton wool spots: Fluffy white patches on the retina caused due to damage of retinal nerve fibers.

3.    Venous beading: Also known as venous looping, it is the thinning of venous walls and venous dilation leading to looping.


  • A person has severe non-proliferative diabetic retinopathy when there are numerous retinal hemorrhages, cotton wool spots, venous beading, and abnormalities of blood vessels. Most people with this condition proceed to proliferative diabetic retinopathy.


Diagnosis of Non-Proliferative Diabetic Retinopathy

Diagnosis and monitoring of diabetic retinopathy is done with diagnostic tests including:

  • Standard Fundus Photography: To monitor posterior pole of the eye, macula, and optic nerve.
  • Widefield Fundus Photography: To monitor more than 80% of the retinal area.
  • Stereoscopic Fundus Photography: 3-d fundus photography to monitor vascular abnormalities.
  • Fluorescein Angiography: to evaluate the condition of retinal blood vessels.
  • Optical Coherence Tomography: To detect diabetic macular edema and to measure retinal thickness.
  • B-scan ultrasound: to detect retinal detachments and vitreous hemorrhages.
  • Slit lamp exam: Biomicroscopic retinal images to examine the retina.

Prevention of Diabetic Retinopathy

  • Get periodical eye examinations.
  • Control blood sugar levels in target range.
  • Maintain blood pressure at healthy levels.
  • Quit smoking.
  • Maintain cholesterol in healthy range.
  • Reduce intake of salt.
  • Maintain healthy diet.
  • Reach your ideal BMI (body mass index). Lose weight.
  • Get 150 minutes of exercise every week.
  • Limit consumption of alcohol.