Course and stages of diabetic retinopathy

Course of diabetic eye diseases

Diabetic retinal disease, or diabetic retinopathy, undergoes a gradual course that can be treated well in the early stages. In the advanced stage, treatment is much more difficult and sometimes no longer possible without loss of function or permanent damage. Diabetic retinopathy can be divided into the following forms:

Early stage: Non-proliferative diabetic retinopathy (NPDR)

In this early stage of the disease, vascular dilatation (microaneurysms), retinal bleeding, fat deposits (hard exudates), capillary fluctuations and infarcts of the nerve fiber layer (so-called cotton wool spots) can occur. This phase can be divided into an easy and a difficult form. In the mild form of NPDR, the disease does not require any treatment other than optimal blood sugar control. Since patients at this stage of development usually do not notice any symptoms, the condition of the eyes must be checked regularly. If the pathological findings worsen, laser treatment of the retina may be necessary. Timely therapy for the disease can stop its progression.

Late stage: Proliferative diabetic retinopathy

In the late stage, the body reacts to the persistent undersupply caused by the damaged vessels with the formation of new vessels (neovascularization). Due to the changed wall structure, however, the new vessels are leaky, bleed easily and allow fluid into the retina. There is a risk of sudden vitreous bleeding, which can lead to sudden and severe visual impairment and even blindness. It is also possible for scar membranes to form on the retina, which contract the retina and cause retinal detachment. This also has a negative impact on eyesight.

If the retinopathy is left untreated, new vessels can also form on the iris and in the corner of the eye (the structure where the eye fluid drains off), which can cause the intraocular pressure to rise sharply.

This late developmental stage of proliferative diabetic retinopathy is in urgent need of treatment.

Late stage: Diabetic macular edema

If the diabetic retinal changes affect the macula (point of sharpest vision), we call that diabetic maculopathy. As a rule, liquid escapes from the small vessels. A swelling of the center of the retina forms, a so-called macular edema. Macular edema impairs visual function and, without treatment, can lead to permanent damage to the central retina with permanent loss of function of the eye. Timely therapy is therefore crucial at this advanced stage.