non proliferative diabetic retinopathy

Non proliferative diabetic retinopathy

Term retinopathy refers to any problem than happens in the most important layer of your eye, Retin, that is responsible for sensation of visual stimulus.

Beside many other problems that one with diabetic mellitus will suffer from, eye involvement is one of the most common and most debilitating problem in these patients.

If you have question about any eye problems that diabetic mellitus patients could have, then you are in right place.


non proliferative diabetic retinopath


What you will read next:

Diabetic retinopathy

types of diabetic retinopathy

Changes in retinal vessels during diabetes

Symptoms of diabetic retinopathy

Prevent the progression of retinopathy

The risk factors for diabetic retinopathy

Non-proliferative retinopathy

Phases of non-proliferative retinopathy

Diagnosis of non-proliferative diabetic retinopathy

Treatment of non-proliferative diabetic retinopathy

Rapid prevention of patient blindness



Diabetic retinopathy

One of the problems that patients with diabetic mellitus may experience during their illness is eye problems. In diabetes, we see damage to the walls of blood vessels, in other words, diabetes causes inflammation and changes in the walls of blood vessels (especially small arteries).

Any small vessels, especially those in eyes and kidneys,  are among arteries that most commonly involved in people with diabetes.

The retina and its associated components play a key role in our vision. Retinal dysfunctions are called retinopathy, and if the cause of these disorders is diabetes, we use the term "diabetic retinopathy".

The retina is a light-sensitive tissue located behind the eyeball and has very close communicates with the optic nerve and blood vessel.

Diabetic retinopathy develops slowly over a period of time when the patient has diabetes.

 In the early stages, diabetic retinopathy is asymptomatic. Slight visual symptoms gradually develop and can lead to blindness if blood sugar is not controlled.  The most common cause of blindness in the world is "diabetic retinopathy"


Types of diabetic retinopathy

Damage to retina layer in diabetic patients classifies into two types:

1. Non-proliferative diabetic retinopathy

2. Proliferative retinopathy


1. Non-proliferative diabetic retinopathy:

This stage is the first and mildest form of diabetic retinopathy that can be asymptomatic.


Non-Proliferative retinopathy further has three stages:

• Mild non-proliferative retinopathy

• Moderate non-proliferative retinopathy

• severe non-Proliferative retinopathy

Later in this writing we will talk in detail about diabetic non-proliferative retinopathy.


2.Proliferative retinopathy

The most advanced stage of retinal involvement is diabetic patients is named proliferative retinopathy

In this stage there is formation of new vessels in the retina. The term proliferative has been chosen for this reason that means reproduction.

New vessels do not have the characteristics of a healthy and normal vessel. In other words, at this stage, we see the formation of new vessels that are not normal in microscopic appearance and biologic function.


Changes in retinal vessels during diabetes

During diabetes, the walls of the blood vessels become inflamed. These changes are more common in smaller and thinner arteries.

Retinal blood vessels are also inflamed and altered during diabetes, as a result of which the retinal arteries become swollen, fragile and weak. As the disease progresses, blood leakage occurs through the wall of the damaged vessel.

Sometimes the vessel is completely blocked and the affected tissue will die.


Symptoms of diabetic retinopathy

In the early stages, the patient has no clinical symptoms, and often when the patient becomes symptomatic, the changes in the eye are in advanced stages, and unfortunately sometimes the first symptom is complete loss of vision.

People with diabetic retinopathy may have the following symptoms:

  • Color vision is impaired in these people.
  • They lose their clear vision.
  • In their field of vision, these people see colored spots or dark stripes that seem to be immersed in environment. We call this sign beyond or fly.
  • Decreased night vision.
  • Sometimes wider spots in the visual field of these people cause vision blockage.
  • Occasionally they experience sudden or complete loss of vision.


Prevent the progression of retinopathy

Regular and planned eye examination should be scheduled to diagnose and treat the disorders in the early stages before any type of vision lose happens.

Diabetic retinopathy is usually present in both eyes, and regular examination of both eyes at regular intervals is essential. 


Retinopathy in type 1 diabetes:

In people with type 1 diabetes, an eye examination is needed five years after the onset of diabetes. 


Retinopathy in type 2 diabetes:

Usually, ten years after the onset of type 2 diabetes, we see diabetic retinopathy, so people with type 2 diabetes should have an ophthalmological examination as soon as their diabetes are diagnosed.

Because type 2 diabetes begins years before the clinical diagnosis has been made, the patient is unaware of his or her diabetes, and at the time of diagnosis, the patient may have already some stages of diabetic retinopathy.


The risk factors for diabetic retinopathy

Remember that everyone with diabetes is at risk for retinopathy, but if a person with diabetes has the following characteristics, there are increased risk of developing diabetic retinopathy:


  • long lasting diabetes.
  • Have hypertension (high blood pressure).
  • Pregnancy.
  • Tobacco consumption (cigarettes, etc.)
  • Have high blood fats


Non-proliferative retinopathy

As mentioned before, the first stage of diabetic retinopathy is called "non-proliferative retinopathy". In the following, we will explain this disorder in more detail.

Retinal changes that may lead in functional disorders of visual role of eye during diabetes are called diabetic retinopathy.

The term proliferative is used when new and abnormal blood vessels are seen by an ophthalmologist when examining the inner side of eye ball with a specific device.

In the non-proliferative retinopathy stage of diabetic retinopathy, new vessels have not yet been formed at the retia layer of the eye.


Stages of non-proliferative retinopathy

Non-proliferative diabetic retinopathy has three stages:


  • Mild or primary non-proliferative diabetic retinopathy
  • Moderate non-proliferative diabetic retinopathy
  • Severe non-proliferative diabetic retinopathy


  • Mild or early non-proliferative diabetic retinopathy:

At this stage, the patient has at least one microaneurysm(spindle like enlargement seen in small arteries mainly because of weakness occurred in their walls) seen through examination of the retina layer.

The patient usually has no symptoms at this stage.


  • Moderate non-proliferative diabetic retinopathy:

The ophthalmologist observes superficial and deep hemorrhages and numerous microaneurysms on examination of the patient's eye.

Retinal nerves can also be damaged by clogged arteries, which appear as white spots on examination that are called "cotton wool spots ".


  • Severe non-proliferative diabetic retinopathy:

Bleeding becomes more extensive and microaneurysms increase and are seen everywhere in the retina.

In the examination, there is a special rule for this phase, known as the "4 2 1" rule, which is as follows:

First (1), the end of the eye is divided into four parts:

Intra-arterial bleeding and microaneurysms are seen in four parts(4)

Venous hemorrhage is seen in two(2) or more parts

Abnormal changes in the small vessels inside the retina, known as " Intraretinal microvascular abnormalities (IRMA) ", occur in the severe phase of non-proliferative retinopathy and should be seen in at least one of the four parts of the retina.


Diagnosis of non-proliferative diabetic retinopathy

In the early stages of diabetic retinopathy, there are no visual symptoms, so only regular eye examination by an ophthalmologist can diagnose eye damage caused by diabetes, so it is necessary for one with diabetes to have an ophthalmological examination according to the following schedule.


Ophthalmologic examination is mandatory in people with type 2 diabetes as soon as their diabetes is diagnosed, and it is necessary to repeat this examination annually if there is no sign of retinopathy.

Ophthalmologic examination in one with type 1 diabetes should be performed five years after the onset of diabetes and repeated annually in the absence of retinopathy.

In case of retinopathy, the intervals of examination are reduced to few months or even weekly depends on the severity of retinopathy.

With exact control and proper treatment, the rate of visual impairment and blindness can be decreased.


Brief review of diagnostic examinations

 During the examination, a drop is applied to dilate the pupil in the patient's eye to have better and wider view.

Opening the pupil allows the ophthalmologist to easily see the space in your eyes and the retina with the specific camera.

Several photos are taken by the camera from the retina layer of your eyes.

In addition, corneal ulcers, lens condition, and eye pressure are monitored during the examination.

Abnormal changes in the retinal arteries, possible bleeding, and damage to the nerves at the retinal layer will also be closely monitored.


In addition to routine examinations, specific methods of imaging such as fluorescein angiography or OCT (a type of eye imaging) may be used at the doctor's decision.


Treatment of non-proliferative diabetic retinopathy

Several factors play a role in choosing the best type of treatment.

In early stages of non-proliferative diabetic retinopathy, scheduled and careful follow-up is all that may be needed.

Proper blood sugar control can slow the progression of retinal damage.

But you may need some extra treatment if more advanced stages of retinopathy in seen during eye examination.

In summary, the changes that happen in non-proliferative retinopathy based on severity that may need extra treatments are:


Retinal bleeding in non-proliferative diabetic retinopathy

When a diabetic person has high blood sugar for a long time, inflammatory changes occur in the walls of the small and thin arteries of the eye.

As a result of these changes, the vessel wall loses its integrity and weakens, and sometimes small bumps (protrusion of the vessels wall) are formed along its path, which is called microaneurysm. These small bumps can rupture and cause limited bleeding.


If these bleedings are superficial, they look like a candle flame during the examination, which is called "flame shape" bleeding, and if the bleeding is deep, it looks like a dot at the retinal layer of the eye, and called "dot and blot hemorrhage ".


Hard exudates

As a result of the damage that above normal blood sugar made, the vessel wall weakens and the fats and proteins that are in the bloodstream, causing yellow and waxy deposits at the base of the eye, which are called "hard exudates".

In addition, due to the weakness of the arterial wall, the veins dilate and twist. This view of bloody and tortuous vessels is called "Tortuosity".


macular edema?

The last stage of diabetic retinopathy that happens in severe non-proliferative retinopathy is "macular edema".

 The macula, or yellow spot, is the most sensitive part of the retina, and we need healthy macula to have a clear and complete visual sensation.

When leakage and occlusion of the vessel increase too much, the macula swells and the person loses clear vision.


Quick prevention of patient blindness

The most common cause of vision loss in this group is macular edema.

If the patient has macular edema and the diameter of this edema be small enough (the distance from the edematous area to the center of the macula is less than five hundred microns) then laser treatment must be performed in order to keep patient's clear an accurate vision.






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