Specifications

75 III For Providers
The EyePACS Handbook: Tools for Program Success
Communicating Screening Results to Patients & Treatment Options
Answers to Common Questions about Screening Results and Treatment
What are the Stages of Diabetic Retinopathy?
Diabetic retinopathy has four stages:
1. Mild Nonproliferative Diabetic Retinopathy. At this earliest stage,
microaneurysms occur. They are small areas of balloon-like swelling in the
retina's tiny blood vessels.
2. Moderate Nonproliferative Diabetic Retinopathy. As the disease progresses,
some blood vessels that nourish the retina are blocked.
3. Severe Nonproliferative Diabetic Retinopathy (NPDR). Many more blood
vessels are blocked, depriving several areas of the retina with their blood supply.
These areas of the retina send signals to the body to grow new blood vessels for
nourishment.
4. Proliferative Diabetic Retinopathy (PDR). At this advanced stage, the signals
sent by the retina for nourishment trigger the growth of new blood vessels. This
condition is called proliferative retinopathy. These new blood vessels are
abnormal and fragile. They grow along the retina and along the surface of the
clear, vitreous gel that fills the inside of the eye. By themselves, these blood
vessels do not cause symptoms or vision loss. However, they have thin, fragile
walls. If they leak blood, severe vision loss and even blindness can result.
How is diabetic retinopathy treated?
During the first three stages of diabetic retinopathy, no treatment is needed, unless the
patient has macular edema. To prevent progression of diabetic retinopathy, patients
with diabetes should control their levels of blood sugar, blood pressure, and blood
cholesterol.
Proliferative diabetic retinopathy (stage 4) is treated with laser surgery. This procedure
is called panretinal or scatter laser treatment. Panretinal laser treatment helps to shrink
the abnormal blood vessels. A doctor places 1,000 to 2,000 laser burns in the areas of
the retina away from the macula, causing the abnormal blood vessels to shrink.
Because a high number of laser burns are necessary, two or more sessions usually are
required to complete the treatment. Although patients who receive this treatment may
notice some loss of side vision, the procedure can save the rest of their sight. Scatter
laser treatment may slightly reduce color vision and night vision.
Panretinal laser treatment works better before the fragile, new blood vessels have
started to bleed. That is why it is important for diabetic patients to have regular eye
exams. Even if bleeding has started, laser treatment may still be possible, depending on
the amount of bleeding.