Non Proliferative Diabetic Retinopathy - Symptoms & Treatment

It is an early stage of diabetic retinopathy that is further divided into three stages which are as follows.

Stage 1: Mild Non-Proliferative Diabetic Retinopathy

1. Also called background retinopathy, this first stage involves microaneurysms in the small blood vessels of your retina. These bulges or swelling may cause these blood vessels to leak small amounts of blood in the retina.
2. Usually, there are no vision problems at this stage. However, you must keep your blood sugar and cholesterol levels under control. If this condition is diagnosed in both eyes, the chances of progression to the third stage in the next three years are increased by 25%. 

Stage 2: Moderate Non-Proliferative Diabetic Retinopathy

1. In this stage, the increased swelling of the blood vessels interferes with adequate blood flow to the retina, preventing proper nourishment. It causes a buildup of blood or fluid in the macula (macular oedema), which can cause problems with your straight-ahead vision while reading or driving.
2. This stage of diabetic retinopathy has a greater chance of affecting your vision. 

Stage 3: Severe Non-Proliferative Diabetic Retinopathy

1. The third stage of non-proliferative diabetic retinopathy includes the blockage of more blood vessels, causing a massive decrease in the blood flow to the retina. Due to this lack of blood, your body receives signals to grow new blood vessels in the retina.
2. If the blood vessels close completely, the condition is called macular ischemia, causing blurry vision with dark spots. There is a very high chance of losing your vision at this stage. 

There are usually no symptoms in the non-proliferative stage of diabetic retinopathy. However, non-proliferative diabetic retinopathy symptoms only occur when there is major damage in the eye during these stages. The symptoms include:

1. Blurred vision
2. Seeing dark spots or floaters
3. Low visibility at night
4. Colour blindness
5. Loss of vision

Diabetes is the primary cause of non-proliferative diabetic retinopathy. Over time, diabetes can damage all the blood vessels in your retina, including veins, arteries, and capillaries. Anyone with gestational, Type 1, and Type 2 diabetes can get mild non-proliferative diabetic retinopathy. When vision gets affected in the moderate or severe stage, it is due to macular oedema, macular ischemia, or both.

What are Non-Proliferative Diabetic Retinopathy Risk Factors?

Anyone with diabetes can develop non-proliferative diabetic retinopathy. However, the longer you have diabetes, the more prone you are to get this condition. Other factors that can increase your chances of diabetic retinopathy include:

Other medical conditions, like high blood pressure and cholesterol

1. Heredity
2. Pregnancy
3. Unhealthy diet
4. Sedentary lifestyle

If you have diabetes, you must do the following to prevent non-proliferative diabetic retinopathy:

1. Get annual eye exams and physical checkups
2. Discuss any changes to your vision with the doctor
3. Control the levels of blood sugar, blood pressure, and cholesterol
4. Exercise regularly
5. Avoid smoking
6. Take medications as prescribed

An opthalmologist (eye doctor) will first evaluate your medical history to detect difficulties in vision, diabetes, and other conditions that may affect vision. The eye doctor will then conduct a comprehensive eye examination to diagnose non-proliferative diabetic retinopathy. The test measures the following parameters:

1. Visual acuity test: This test is done to measure of the clarity of vision and the ability of the eye to distinguish shapes and other details of objects at a distance of 20 feet. The test is performed by reading the smallest letters on a standardised chart. A 20/20 (6/6) vision is considered normal. 
2. Intraocular pressure: Intraocular Pressure (IOP) refers to the eye pressure resulting from fluid buildup. Elevated levels of IOP can cause severe conditions like glaucoma. IOP is measured during the diagnosis of NPDR to rule out glaucoma.
3. Eye muscle function: The primary function of extraocular eye muscles is to control eye alignment and movement. The extraocular muscle functioning test can help determine any weakness or defect in the muscles which can cause uncontrolled eye movements. 
4. Pupillary response: Pupillary response is a reflex that causes a change in pupil diameter as a response to changes in the intensity of light striking your retina. 
5. Peripheral vision: Also known as side vision, it is the ability to see things around you without turning your head. It is used to see something “out of the corner of your eye”. 

Next, the ophthalmologist will put drops in your eyes to dilate your pupils. This exam checks for:

1. Retinal swelling
2. Abnormal blood vessels
3. Growth of new blood vessels
4. Bleeding in the centre of the eye

Other diagnostic tests include:

1. Fluorescein angiography: Once your eyes are dilated, the doctor injects a dye in the vein of your arm to see how the blood flows to the eyes. The images of the dye circulating inside your eye help determine blood vessels that are blocked, broken, or leaking. 
2. Optical Coherence Tomography (OCT): The test uses light waves to produce cross-sectional images of the retina. The pictures show the thickness of the retina and help determine the amount of fluid leaked into the retina. 

The goal of the treatment is to stop or slow the progression of the disease. Regular monitoring and controlling blood sugar levels may be the only required treatment in the early stages of non-proliferative diabetic retinopathy before damage to the retina occurs. For the non-proliferative stage that includes some eye damage, treatment options include:

1. Eye Medications: The doctor will inject steroids or anti-vascular endothelial growth factor (anti-VEGF) drugs into your eye to stop inflammation and prevent new blood vessel formation. 
2. Laser Surgery: When the disease advances, blood vessels can leak into the retina, causing macular oedema. Laser treatment is used to stop this leakage of blood and fluid in the eye. Photocoagulation, also known as focal laser treatment, is the most common treatment for non-proliferative diabetic retinopathy. It uses a laser to target a specific blood vessel in the macula to reduce the chances of macular oedema worsening. It is an outpatient procedure done in the doctor’s office. 

When diabetic retinopathy advances from the non-proliferative to the proliferative stage, you may need a different type of laser therapy or eye surgery called vitrectomy. 

If left untreated, non-proliferative diabetic retinopathy can convert into proliferative diabetic retinopathy and cause several complications. 

1. Macular oedema: Sometimes, damage to the retinal blood vessels can cause oedema (buildup of fluid) in the macula (the round, centre area of the retina), which may make the retina swell and affect your vision. 
2. Macular ischemia: When small blood vessels close completely, blood cannot reach the macula, causing blurry vision. 
3. Vitreous haemorrhage: When the disease advances to the proliferative stage, the new blood vessels may leak blood into the centre of your eye, making you see a few dark spots or completely blocking your vision. 
4. Retinal detachment: The abnormal blood vessels in the eye may trigger the growth of scar tissue, pulling the retina away from its normal position (back of the eye). This can cause flashes of lights, floaters in your vision, or severe vision loss. 
5. Glaucoma: New blood vessels that grow in the front of the eye can hamper the normal flow of fluid, causing an increase in intraocular pressure. This pressure can damage the optic nerve. 
6. Blindness: If conditions like diabetic retinopathy, glaucoma, and macular oedema are poorly managed, they can lead to complete blindness. 

If you have diabetes, you must get an eye exam once every year. Pregnant women with diabetes should get an eye exam during their first trimester. Apart from the scheduled eye appointments, you should call your eye doctor when you experience the following:

1. Blurry vision
2. Flashes of lights
3. Black spots in the vision
4. Holes in the vision

Any person with diabetes has a risk of developing non-proliferative diabetic retinopathy. While mild and moderate stages of this disease do not need immediate treatment, however, the severe non-proliferative stage can lead to vision loss if not treated. Prompt diagnosis and treatment can stop or slow the disease progression and prevent vision loss. The most effective way to prevent the condition is to manage diabetes and control your blood sugar levels. 

You can consult an expert at HexaHealth if you experience non-proliferative diabetic retinopathy symptoms or any new vision changes. Our team will help you manage the condition to slow disease progression. Additionally, we will connect you with the right doctor or surgeon near your location if further treatment is required.