Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults, yet most Americans over 40 don’t know its symptoms or the risk factors.
This article answers your questions about early signs and symptoms of the diabetic eye disease, including:
What is the connection between diabetes and eyesight?
What are the four stages of diabetic retinopathy (DR)?
What are the early signs of mild to moderate non-proliferative diabetic retinopathy (NPDR)?
What are the symptoms of severe NPDR?
What are the symptoms of proliferative diabetic retinopathy (PDR)?
What complications can diabetic retinopathy cause?
What causes blank spots in vision?
When should I see a doctor about diabetic eye problems?
How should I prepare for a diabetic eye exam?
What tests will a doctor run at a diabetic eye exam before giving a diabetic retinopathy (DR) diagnosis?
What services does Ability Central offer people with vision problems?
What is the connection between diabetes and eyesight?
Diabetes can cause many types of vision problems, including vision loss or blindness. Diabetic eye diseases include:
Diabetic retinopathy
What are the four stages of diabetic retinopathy (DR)?
Diabetic retinopathy (DR) is a serious eye condition that can lead to permanent vision changes or blindness.
Also called diabetic eye disease, DR happens when high blood sugar causes blood vessels in the eyes to break down. DR typically affects both eyes and can be divided into two types: non-proliferative and proliferative.
These types identify the four stages of DR:
Stage 1: Mild non-proliferative diabetic retinopathy (NPDR)
Stage 2: Moderate NPDR
Stage 3: Severe NPDR
Stage 4: Proliferative diabetic retinopathy (PDR)
Some experts also consider a “fifth” stage, severe or extreme PDR.
To learn more about the stages of diabetic retinopathy, see 7 Things to Know About Diabetic Retinopathy (DR).
What are the early signs of mild to moderate non-proliferative diabetic retinopathy (NPDR)?
Part of what makes diabetes-related retinopathy so serious is that in its earliest stages, people with DR may not notice any symptoms. The only way to find early DR is through a comprehensive eye exam.
In mild NDPR, blood vessels in the eye may swell and lead to tiny bulges called microaneurysms. An ophthalmologist or eye doctor will look for these via tests like a dilated eye exam.
The first noticeable symptoms start in moderate NDPR, when the retina’s blood vessels become blocked. Small amounts of bleeding or leaking fluid cause mild vision issues like blurriness.
What are the symptoms of severe non-proliferative diabetic retinopathy (NPDR)?
Unfortunately, many people do not realize they have DR until it progresses to severe NDPR. Vision problems like blurriness and floaters are common in NDPR, as is the risk of developing macular degeneration (also called macular edema), a DR complication that can lead to permanently distorted vision.
Severe NDPR symptoms include:
Blurry vision.
Dark or blind spots.
“Floaters,” specks or dots that block vision.
Poor night vision.
Difficulty reading.
Trouble seeing distant objects.
Doctors use the 4-2-1 rule to diagnose severe NPDR. During an eye exam, doctors divide the eye into four sections and examine each for symptoms. This
The 4-2-1 rule means:
● Bleeding is present in all four quadrants of the retina.
● Venous beading appears in two or more quadrants.
● Abnormal blood vessels start growing in at least one quadrant.
People with severe NPDR have a 52% risk of developing PDR within one year.
What are the symptoms of proliferative diabetic retinopathy (PDR)?
Proliferative retinopathy is the most advanced stage of the eye disease. It requires urgent medical care or risks permanent vision loss.
In response to major blockages in the retina, the brain sends signals to grow new blood vessels. However, these blood vessels are weak and fragile, making them much more likely to burst or leak into other parts of the retina.
When blood vessels bleed into the vitreous, the clear gel-like substance that fills the center of the eye, this leakage causes severe vision problems.
What complications can develop from diabetic retinopathy?
Left untreated, diabetic retinopathy can lead to dangerous complications or permanent eye damage.
These include:
Glaucoma, a progressive group of eye diseases that damage the optic nerve. The optic nerve sends visual information from the eye to the brain.
Macular degeneration, also known as macular edema. As the leading cause of blindness in people with DR, macular edema occurs when leaking blood vessels cause the macula (the central part of the retina) to swell, distorting vision. About half of people who develop DR will also develop macular edema.
Retinal detachment. Swelling in the retina causes it to detach from the rest of the eye.
Retinal tears. Swelling or blockage in the retina leads to a hole or tear in the eye tissues.
Vitreous hemorrhage. Blood in the vitreous humor causes blurred vision or near-complete vision loss.
What causes blank spots in vision?
Blank spots in your vision, also known as blind spots, can be a normal part of the eye with no long-lasting impacts.
However, see your eye doctor right away if:
The blind spot grows
You have sudden vision changes
The blind spots appear with a headache or eye pain
You develop symptoms of other eye diseases
When should I see a doctor about diabetic eye problems?
People with diabetes should see an eye care professional annually for a complete eye exam. Contact your doctor if you notice a vision change before your scheduled annual exam.
How should I prepare for a diabetic eye screening?
Before going to your annual eye exam, make a note of the following:
Changes in your vision, including floaters, blurred vision, poor night vision, and flashing lights.
When the symptoms began.
Your blood sugar levels when symptoms occur.
Any medical changes, including new medications.
What tests will a doctor run at a diabetic eye exam before giving a diabetic retinopathy diagnosis?
During the diabetic eye exam, your doctor will look for eye abnormalities. Tests may include:
Traditional eye screening for visual acuity.
Fluorescein angiography. Doctors inject special dye into the bloodstream in order to track how it passes through your body. This test finds blood vessels that are closed, broken, or leaking.
Tonometry, which measures the pressure inside the eye. See Glaucoma: Seven Quick Facts You Should Know for more information.
Optical coherence tomography (OCT), which shows the thickness of the retina and how much fluid has leaked into the retina.
What services does Ability Central offer people with vision problems?
Ability Central offers a library of articles to help you understand vision issues.
In addition, we maintain a searchable database for mobile devices with low-vision accessibility features, as well as and a database collection of nonprofit service providers specializing in vision and eye diseases.
Where can I get more information about DR?
To learn more about diabetic retinopathy, see:
What Should I Do After a Diabetic Retinopathy (DR) Diagnosis?
Diabetic Retinopathy (DR): Long-term Care for Diabetic Vision Loss
Additional Information
The content provided in this article is for informational purposes only and is not intended as a substitute for legal, medical, or other professional advice. While we strive to provide accurate and up-to-date resources, some information may become outdated or incomplete. Always consult with your provider about personal medical concerns.
