Stages of Diabetic Retinopathy

Within weeks of beginning of diabetes, damage to small blood vessels of the eye commences. By the time diagnosis of diabetes is made, some amount of damage is already done. To save vision and to avoid diabetes complications of the eye, frequent eye examinations are needed.

Diabetic Retinopathy Stages

  • Mild non-proliferative diabetic retinopathy.
  • Moderate non-proliferative diabetic retinopathy.
  • Severe non-proliferative diabetic retinopathy.
  • Proliferative diabetic retinopathy.

Diabetic retinopathy is caused due to high blood sugar levels and is a condition of small blood vessels in the retina.  This condition shows symptoms only in the latter stages after considerable amount of damage is done. It starts early on without any vision changes. It is only later that vision is affected.

Identification and Diagnosis of Diabetic Retinopathy

All diabetic retinopathy stages are seen on fundus examinations and retina photos. Since diabetic retinopathy is a progressive illness, identifying it in the early stages is very important to improve prognosis. Providing treatment in the early stages stops deterioration of vision. For this, eye examinations that look for microaneurysms are needed as microaneurysms are the first signs of diabetic retinopathy.

What is a microaneurysm?

An aneurysm is the enlargement and swelling of a blood vessel (generally an artery). It can occur in any part of the body. It is caused due to damaged blood vessels, deposits of fat and diabetes. A microaneurysm is the bulging or swelling of tiny blood vessels (arteries, arterioles and capillaries). This is common in people with diabetes and often occurs in the retina. Retinal microaneurysms, which are classic signs of diabetic retinopathy, look like tiny protrusions of blood in the arteries or veins. They are susceptible to blood leaks and cause edema.

What are the symptoms and signs of microaneurysms?

Microaneurysms do not exhibit any symptoms. That is why a person in an early stage of diabetic retinopathy does not show any symptoms. People with poor diabetes control have microaneurysms in the capillaries of their retinae. Upon examination, they appear like red dots, but do not affect vision. In a Fluorescein angiography test, microaneurysms are seen as brightly-colored. Microaneurysms in the retina are the first signs of non-proliferative diabetic retinopathy.

Diagnosis of Diabetic Retinopathy

For the purposes of diagnosing diabetic retinopathy and identifying microaneurysms, certain gold standard tests are used. When these tests are done periodically, people with diabetes can successfully manage diabetic eye problems. These tests include:

  • Fundus Photography or Fundus examination (dilated)
  • Stereoscopic Fundus Photography
  • Slit Lamp Examination.
  • Fluorescein Angiography.
  • Widefield Fundus Photography.
  • Widefield Fluorescein Angiography.

As diabetic retinopathy stages progress from mild non-proliferative diabetic retinopathy to proliferative diabetic retinopathy, changes occur in the retina. These changes appear in the above tests in the form of microaneurysms, hemorrhages, neovascularization, and diabetic macular edema.