All You Wanted to Know About the 4 Stages of diabetic Retinopathy

Medicare Benefits Solutions
May 9, 2022

Diabetic retinopathy is a progressive disease caused by high blood sugar inflicting damage on blood vessels in your retina, the light-sensitive innermost lining of the eyeball. National Eye Institute statistics indicate that “from 2010 to 2050, the number of Americans with diabetic retinopathy is expected to nearly double, from 7.7 million to 14.6 million.”

Diabetic retinopathy is the most common cause of blindness and reduced vision among people with diabetes, according to WebMD. Having any type of diabetes (Type 1, Type 2 or gestational) puts you at risk. If you have diabetes, be proactive by going for your annual eye exams, raising concerns with your doctor and getting familiar with the warning signs.

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Diabetic Retinopathy Symptoms

The beginning stages of retinopathy may not present any symptoms. If you experience any of the following signs, schedule a visit with an ophthalmologist qualified to test for diabetic eye disease:

  • Increasing floaters, which are small spots that appear to float in your field of vision
  • Vision that is blurry, distorted, lessening or changing in color
  • Reduced night vision

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Retinopathy Causes and Symptoms

Diabetes is a chronic disease that occurs when an elevated amount of blood glucose (sugar) remains in the blood for too long, causing abnormalities in major organs throughout your body. Your eyes are no exception. High blood sugar levels can impair your retina’s tiny blood vessels, causing swelling and leaking. In some cases, new abnormal blood vessels emerge on the retina’s surface.

Managing your blood sugar is the first step in preventing diabetic retinopathy and other complications like diabetic ketoacidosis. Monitor your blood pressure and cholesterol levels as well. Sustain a healthy diet, and engage in daily physical activities. This does not have to be a solitary journey. Tap into support programs that can help you manage your diabetes.

Diabetic Retinopathy Diagnosis

To get you ready for your diabetes vision screening, your eye specialist will most likely dilate your eyes with drops and test your eye pressure. If further evaluation is needed, your doctor can perform different procedures to capture images of your retina.

A fluorescein angiogram (FA) is one method used to diagnose diabetic retinopathy and typically takes about a half-hour. Fluorescein is a yellowish dye that is injected through a vein in your arm, and then travels to your eyes, causing them to cast a bright shine. A special camera takes pictures as the dye moves through the retina, giving your ophthalmologist a precise view of your eye’s blood vessels and any areas that require treatment.

Optical coherence tomography (OCT) is another method that uses light waves for a non-invasive imaging exam. Providing a view of cross-sectional images of the individual retina layers, the OCT enables your ophthalmologist to gather metrics on the thickness of your retina and the amount of accumulated fluid.

Diabetic Retinopathy Treatment

There are four stages of diabetic retinopathy, ranging from mild retinopathy to end-stage diabetic retinopathy. Identifying what phase of the disease you are in can help determine the most effective treatment. Treatments may include:

  • Injections of anti-vascular endothelial growth factor (anti-VEGF) medication to reduce swelling and improve vision
  • Laser treatment to shrink or control leakage from blood vessels
  • Surgery for scar tissue removal, blood vessel repair or extraction of the vitreous fluid (gel in your eye) causing cloudiness

What Are the Four Stages of Diabetic Retinopathy?

Stage 1: mild non-proliferative diabetic retinopathy

During mild or background retinopathy, your ophthalmologist can detect small bulges, known as microaneurysms. If you are not having any vision problems, treatment may not be necessary, but your doctor will want to monitor these bulges because they can cause blood leakage into your retinas.

Having microaneurysms in both eyes increases your chances of advancing to Stage 3 within a three-year period. Be sure to schedule another screening in a year. In the meantime, this development can serve as a reminder to continue your diligence in controlling your blood glucose, blood pressure and cholesterol levels.

Stage 2: moderate non-proliferative diabetic retinopathy

Moderate or pre-proliferative retinopathy is evident by the swelling of blood vessels in your retina. When you reach stage 2, you are at a greater risk of vision loss, so you will probably need to be checked again in three to six months. In this stage, you are at a greater risk of developing diabetic macular edema (DME). The macula is the part of your eye that helps you see straight ahead, so DME can cause problems with reading and driving.

Stage 3: severe non-proliferative diabetic retinopathy

You have reached stage 3 when the blockage in your blood vessels increases in severity. As blood vessels continue to close off, you may develop a condition called macular ischemia (lack of blood supply), causing blurry vision with floaters. Floaters are spots or small shapes that appear to be floating in front of your eye.

While occasional floaters are a natural part of aging, a sudden increase is a sign of a more serious condition. Your risk of vision loss is higher in this stage. Though treatment can potentially halt the progression, vision already lost is likely permanent.

Stage 4: proliferative diabetic retinopathy

Stage 4 is an advanced stage of the disease where new blood vessels develop in your retinas and vitreous, which is a gel-like material. The growing blood vessels are thin, weak and frequently bleed, a prelude to scar tissue. Retinal detachment is when scar tissue pulls the retina from the back of the eye, often resulting in permanent loss of straight-ahead and peripheral vision.

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Diabetes Vision Care

Vision care is especially important if you have diabetes. Though Medicare does not cover routine diabetes vision care across the board, Medicare recipients with diabetes who are enrolled in Part B have coverage for annual eye exams.

These exams are intended to check for early-stage diabetic retinopathy and to monitor changes. This is essential for early diagnosis, slowing the advancement of the disease and preventing blindness.

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