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Understanding the Four Stages of Diabetic Retinopathy

Diabetic retinopathy is a progressive disease that can lead to irreversible vision loss if not treated. If you are a diabetic, we hope that message gets your attention. Most people are not even aware they have it until the final stage of the disease. However, an ophthalmologist can diagnose diabetic retinopathy in its early stages before any symptoms appear and protect your vision. Let us help you understand the four stages of diabetic retinopathy.

How Does Diabetic Retinopathy Affect Vision?

The retina is the tissue that lines the back of our eyes. Signals from the retina to the brain give us our vision. Diabetes affects the retina when higher blood sugar levels cause damage to the retina’s blood vessels by blocking them and affecting our vision.

Anyone with type 1 or 2 diabetes can develop diabetic retinopathy including those with gestational diabetes. The longer you have diabetes the risk increases. Diabetes damages blood vessels all over the body, and in our eyes sugar blocks the blood vessels that go to your retina causing them to leak or bleed into the vitreous or gel-like white part of the eye. As the disease progresses, new blood vessels form, but they don’t work very well, and they bleed and leak easily.

Unfortunately, you can have this condition and not know it which is why it’s important for those with diabetes to receive regular eye examinations.

There are few symptoms in the early stages, but as it progresses, you may have the following symptoms:

  • Increasing number of floaters
  • Blurry vision
  • Seeing blank or dark areas
  • Poor night vision
  • Colors look faded or washed out
  • Losing vision

The Four Stages of Diabetic Retinopathy

Mild Proliferative Retinopathy

  • Earliest stage
  • Tiny blood vessels change
  • Small areas swell called microaneurysms
  • Fluid can leak out

Moderate Proliferative Retinopathy

  • Blood vessels swell and change shape
  • Can’t deliver blood to the retina
  • Changes the way the retina looks
  • Can trigger diabetic macular edema (DME)
  • Swelling of areas of retina called the macula

Severe Proliferative Retinopathy

  • Many blood vessels blocked
  • Can’t deliver blood to retina and keep it healthy
  • New blood vessels grow
  • Significant decrease in blood flow to the retina

Proliferative Retinopathy

  • Most advanced stage
  • New blood vessels grow inside retina and vitreous
  • Scar tissue begins to form
  • Can lead to retinal detachment and permanent blindness


If you have diabetes, you should see your ophthalmologist at least once a year for a dilated eye exam. This will give you a head start on any changes to your retina and to begin a treatment plan to prevent its progression.

Treatment begins by keeping your blood sugar level at a healthy level and taking all your medications as prescribed. Blood sugar management may be the only treatment necessary if you catch the disease at an early stage.

There are other treatments to save your vision even if your disease has progressed.

Contact Hecht Eye Institute at (310) 370-5648 if you are a diabetic and want to schedule your annual comprehensive eye exam in Southern California.

Ready to get started?

Schedule your appointment with Dr. Hecht and be on your way to better eye health!