Diabetic retinopathy is a complication of diabetes that affects vision. Nonproliferative diabetic retinopathy describes the earlier stages of the condition before it progresses into the final and most advanced stage.

Diabetic retinopathy is the most common complication of diabetes and can lead to vision loss and blindness. The condition occurs when high blood sugar levels affect the blood vessels at the back of the eye, in the retina. This is a layer of tissue that is sensitive to light and helps enable vision.

Health experts classify diabetic retinopathy into two different types depending on the condition’s severity. Nonproliferative diabetic retinopathy (NPDR) describes the earlier stages of the condition, while proliferative diabetic retinopathy (PDR) refers to the final stage.

The main difference between the two conditions is the presence of atypical blood vessels in PDR, which have a greater potential for serious visual consequences.

In this article, we will define NPDR, discuss how it differs from PDR, and explore prevention strategies.

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Diabetic retinopathy is an eye condition that may lead to vision loss and blindness in people with diabetes. Health experts typically classify the condition into two main types: NPDR and PDR.

NPDR refers to the earlier stages of the condition, where symptoms are typically mild or nonexistent. At this stage, high blood sugar levels begin to weaken the blood vessels present in the eye. This leads to the development of tiny bulges in the blood vessels, known as microaneurysms.

As the condition advances through the different stages of NPDR, more damage occurs to the blood vessels. Eventually, a person will present with signs that a doctor will be able to identify during a routine eye exam.

PDR describes the final and more advanced stage of diabetic eye disease. The term proliferative refers to the production of new and fragile blood vessels that develop at this stage of the condition.

When the condition progresses to this stage, circulation problems with blood vessels deprive the retina of oxygen. This results in the development of new, fragile blood vessels that may begin to grow in the retina and into the vitreous. The vitreous is the gel-like fluid that fills the back of the eye.

However, these new blood vessels are prone to leaking and may also lead to scar tissue developing. Both of these can result in complications and severely affect vision.

Learn more about the stages of diabetic retinopathy.

In the earlier stages of NPDR, people do not necessarily experience symptoms, as they typically develop after the condition progresses. However, people may begin to notice changes in their vision, such as blurriness. Other potential visual symptoms may include impaired color vision, eye floaters, or reduced night vision.

It is often difficult to stage the condition according to symptoms. Instead, an eye doctor will inspect the eye and look for signs to indicate the condition’s progression. The characteristic features of different stages of NPDR include the below.

Diabetic retinopathySigns
Mild NPDRmicroaneurysms only
Moderate NPDRmicroaneurysms and other signs, such as dot and blot hemorrhages, hard exudates (deposits), or cotton wool spots
Severe NPDRan eye doctor may use the 4-2-1 rule to diagnose this stage, which represents:
• hemorrhages being present in all four retinal quadrants
• venous beading appearing in two or more quadrants
• intraretinal microvascular abnormalities are present in at least one quadrant

In the early stages of NPDR, a doctor may not recommend treatment. Instead, they may opt to monitor eye health and check how the condition is progressing. As such, they may suggest that a person attends regular eye appointments as often as every 2–4 months.

They may also emphasize the importance of maintaining blood sugar levels, blood pressure, and cholesterol levels to help slow the condition’s progression and prevent potential complications.

As the condition progresses and symptoms worsen, a doctor may recommend laser therapy or vitrectomy. The latter is a technique that removes and replaces the vitreous humor of the eye.

Currently, there is no cure for diabetic retinopathy, but the condition is manageable. The main strategy to avoid NPDR progressing to PDR is to manage blood sugar levels and keep them within a suitable range. Additionally, it is also important to manage blood pressure and a person’s cholesterol levels and maintain a moderate weight.

Furthermore, if someone requires treatment for diabetic retinopathy, it is vital to receive it as soon as possible. As such, it is essential that a person living with diabetes attends regular annual eye exams.

Learn more about diabetic eye screening.

Health experts classify diabetic retinopathy into two types: nonproliferative and proliferative. NPDR describes the earlier stages of the condition, where blood vessels may begin to swell. A person may also start to notice vision changes. PDR refers to the most advanced stage, where new blood vessels develop and serious visual symptoms could develop.

A person with NPDR may not experience any symptoms. However, it can severely affect their vision if the condition progresses. As such, it is important for individuals to manage their diabetes and attend regular eye screenings.