Non-Proliferative Diabetic Retinopathy : Symptoms, Causes, Treatment, Prevention

Non-proliferative diabetic retinopathy involves the early stage of diabetes complications. Apart from managing diabetes, no specific medical treatment may be needed for non-proliferative diabetic retinopathy.

Diabetic retinopathy is a complication of diabetes in which the blood vessels in the retina are affected. The retina is a layer at the back of the eye and is sensitive to light. High sugar levels over a period of time cause damage to the blood vessel in the retina causing them to leak or get blocked. This can lead to changes in vision and in severe cases vision loss. According to the National Eye Institute, more than half of all people with diabetes go on to develop diabetic retinopathy.⁽¹⁾

How diabetic retinopathy affects the eye depends on the severity of the condition. In earlier stages, it may not be even noticeable. In later stages, as it progresses there may be:

Blurring of vision as the blood vessels leak fluid or blood causing the swelling of the macula, the central part of the retina.

A person may see floaters or small specks appearing in the field of vision. This may be due to leaking of the blood from the damaged blood vessels.

As the blood vessel in the retina gets blocked there may be dark or empty areas in the vision.

There may be vision loss in the advanced stages of diabetic retinopathy. This can be permanent vision loss. This happens as the new blood vessel grow in the retina and cause scar tissue. This leads to retinal detachment.

Non-proliferative retinopathy is known to be the early stage of diabetic retinopathy. It occurs in 3 stages:

1. Mild Non-Proliferative Retinopathy: In these small areas of blood vessels in the retina get blocked causing tiny bulges known as microaneurysms. There may be slight bleeding but the vision may not be affected.
2. Moderate Non-Proliferative Diabetic Retinopathy: In this stage, the person may have small dot-blot hemorrhages. An ophthalmologist may detect small white spots and some hard exudates made of lipids and protein that can leak out of the blood vessels onto the retina.
3. Severe Non-Proliferative Diabetic Retinopathy: In this stage, more blood vessels get blocked and the retina gets deprived of oxygen and nutrients. This may lead to vision loss. The retina may swell up and distort vision. In severe cases, new blood vessels start growing into the retina leading to advanced stages of diabetic retinopathy.

The treatment of non-proliferative diabetic retinopathy involves managing diabetes with blood sugar control, blood pressure control, and lifestyle changes. Frequent eye exams may be needed in case of moderate to severe cases. Some cases may need a laser to treat the leaking blood vessels and prevent further damage. With early detection and treatment diabetic retinopathy can be managed. A regular eye exam can help monitor the health of the retina.

The main cause of non-proliferative diabetic retinopathy is damage to the blood vessel in the retina due to the uncontrolled blood sugar level. The blood vessel suppy the retina with oxygen and nutrients.

The risk factors that can increase the likelihood of occurrence of non-proliferative diabetic retinopathy are:

• Poorly controlled diabetes mellitus. People who are not able to control their blood sugar levels with the help of medication, diet, and lifestyle changes are at a higher risk of developing diabetic retinopathy.
• How long a person has been living with diabetes also increases the risk of non-proliferative diabetic retinopathy. The risk increases more after 10 years of living with diabetes.
• High blood pressure can also increase the risk of damage to the blood vessels in the retina which further increases the risk of non-proliferative diabetic retinopathy.
• High cholesterol level also increases the risk of damage to the blood vessels, increasing non-proliferative diabetic retinopathy risk.
• Pregnant females with diabetes are at a higher risk of non-proliferative diabetic retinopathy.
• Smoking increases the risk of many health conditions including non-proliferative diabetic retinopathy.

In the early stage, some people may not experience any symptoms and hence would not even be knowing they are suffering from any condition. This is why a regular eye exam is essential for early diagnosis and treatment.

As non-proliferative diabetic retinopathy progresses the patient may present the following symptoms:

• Blurred vision, which occur as the blood vessels leak into the retina causing swelling of the macula, the central part of the retina.
• Fluctuating vision, which may be due to changes in blood sugar levels.
• Floaters or small specks or clouds in the field of vision. It occurs due to the leaking of blood from the damaged blood vessels
• Dark or empty areas in vision, which occur as the blood vessel in the retina get blocked.
• Difficulty in seeing at night

Diagnosis of non-proliferative diabetic retinopathy involves a comprehensive eye examination by an optometrist, which may include:

• Visual acuity test: It measures the vision of the patient from a distance
• Dilated eye exam: Eye drops are used to dilate the pupil and examine the retina for the signs of diabetic retinopathy
• Tonometry: It measures the pressure inside the eyes
• Optical coherence tomography: In this, light waves are used to produce detailed images of the retina. This helps a doctor to detect any fluid accumulation behind the retina.
• Fluorescein angiography: A dye is injected into the bloodstream to highlight the blood vessels of the eye. The flow of the dye in the eye is captured with the help of a special camera.

Regular eye examinations are important for people with diabetes as they can be helpful in catching hold of any complication at the earliest and measures can be taken to prevent it from progressing.

Treating and managing non-proliferative diabetic retinopathy in its early stages is pretty difficult as predicting whether or not it will progress to the advanced stage is not possible.⁽²⁾

Research shows progression to be more in the cases of moderate diabetic retinopathy.⁽²⁾ It is more likely to progress to advanced stages.

The treatment and management of non-proliferative diabetic retinopathy aim at preventing the disease from progressing and reducing the risk of vision loss.

The strategies involved to treat non-proliferative diabetic retinopathy are:

• Controlling the blood sugar levels: Keeping the blood sugar levels under control is essential for the management of diabetic retinopathy. This can be done by eating a healthy diet, exercising regularly, and regularly monitoring blood glucose levels.
• Blood pressure control: High blood pressure can worsen diabetic retinopathy. Keeping a check on blood pressure levels can play an important part in the management of diabetic retinopathy.
• Lipid management: High blood cholesterol levels also can worsen diabetic retinopathy. Keeping lipid levels under control can help prevent vision loss.
• Regular eye exams: Getting the eye examined regularly can be helpful in detecting any abnormality at the earliest and preventing vision loss.
• Laser photocoagulation: Laser treatment can sometimes be necessary to treat non-proliferative diabetic retinopathy. It can help seal the leaking blood vessel and prevent further retina damage.
• Medication injections: Medication injections are given into the eye to reduce inflammation and swelling and prevent vision loss.
• Vitrectomy: It is a procedure in which a gel-like substance is removed from the eye and is replaced with a saline solution.

Non-proliferative diabetic retinopathy is a progressive disease and there is a lot one can do to prevent or slow down its occurrence and progression.

• Keeping the blood sugar levels and lipid levels under control
• Exercising regularly
• Using insulin, if prescribed by the healthcare professional
• Strictly adhering to the ophthalmologist treatment plant
• Getting eye examined regularly

These steps can be helpful in lessening the need for treatment and preventing the progression of the disease toward vision loss.

Non-proliferative diabetic retinopathy is an early sign of diabetic retinopathy. Initially, it presents as a limited number of microaneurysms in the blood vessels that bulge and leak into the retina. In its severe stage, these aneurysms have developed throughout the eyes. This slows down the blood supply in the retina.

Having uncontrolled blood sugar levels is its main cause and other factors including high blood pressure and high lipid levels may increase the risk of it.

The condition can very well be managed by keeping the blood sugar levels, blood pressure levels, and lipid levels under control, exercising, eating a well-balanced diet, and getting the eyes checked regularly.

By keeping blood sugar levels in check, following the medications prescribed, and with exercise and diet the progression of the disease can be slowed down.