Non-proliferative diabetic retinopathy is the earliest stage of this diabetes complication. You may not have symptoms, and medical treatments may not be needed aside from diabetes management.

As people with diabetes begin to experience eye-related problems as a result of their condition, diabetic retinopathy can take one of two major stages as it progresses. The early stage is known as non-proliferative diabetic retinopathy.

The eye condition can be treated when it’s diagnosed and treated early enough.

Learn more about the early stage of diabetic retinopathy, including symptoms and treatment options that can help slow or stop it from getting worse and impairing your vision.

The longer you have diabetes, the more likely you are to develop diabetic retinopathy.

More than half of all people with diabetes go on to develop diabetic retinopathy, reports the National Eye Institute. The organization also notes that diabetic retinopathy is the most common cause of vision loss for people with diabetes in the United States.

This is because over time, high blood sugar levels can lead to changes or damage to the blood vessels in the retina, the light-sensitive layer of tissue that lines the back of the eye.

During the early stage, the blood vessels in the retina weaken and develop tiny bulges called microaneurysms. Microaneurysms sometimes leak fluid into the retina, causing swelling in the macula, which is the central part of the retina. Those blood vessels may also close off and prevent blood from reaching the macula, a process known as macular ischemia.

If it progresses into the more advanced form, a network of tiny, fragile new blood vessels begins to grow in the retina. These new blood vessels may leak blood and fluid into the vitreous gel at the back of the eye.

Many people who develop non-proliferative diabetic retinopathy don’t develop any symptoms at all. This means they might not notice any changes to their vision or anything different at all. Others may develop mild symptoms.

As it progresses, you may begin to develop symptoms such as:

  • cloudy or blurry vision
  • dark, floating spots in your field of vision
  • dark spots in the center of your vision
  • trouble seeing well at night

Sometimes those changes come and go, such as trouble seeing objects that are far away at certain times and not others.

Experts generally divide non-proliferative diabetic retinopathy into the following stages of severity:

  • Mild: A few microaneurysms are present.
  • Moderate: A greater number of microaneurysms are present, along with dot hemorrhages and possibly some fluffy white patches known as cotton wool spots and some lipid and protein deposits called hard exudates.
  • Severe: It meets at least one criterion of the 4-2-1 rule, which involves:
    • severe hemorrhages and microaneurysms in all four quadrants
    • abnormal beading of the venous wall in at least two quadrants
    • intraretinal microvascular anomalies (IRMA) in at least one quadrant

Some experts also add a classification for very severe, which describes a situation in which two criteria of the 4-2-1 rule are met.

Although there is treatment that can be very effective for diabetic retinopathy, there is no current cure. The sooner your doctor can diagnose diabetic retinopathy, the better your outcome.

The approach for managing non-proliferative diabetic retinopathy in the early stages is often a watchful waiting approach.

Experts caution that it’s difficult to predict for sure whether you will develop the more advanced stage of diabetic retinopathy if you experience the earlier stage.

Research suggests progression is more likely if you have a moderate form of non-proliferative diabetic retinopathy than if you have a mild form. It’s also more likely it will progress to the more advanced stage of retinopathy from a severe or very severe form of non-proliferative diabetic retinopathy.

Even if you don’t have symptoms, certain actions can prevent severe effects from developing and ultimately save your vision. These include:

  • consistently managing blood sugar levels and keeping them in a healthy range
  • managing your blood pressure
  • lowering your LDL (bad) cholesterol, such as with exercise, medications, or both
  • eating a balanced, nutritious diet full of whole grains, vegetables, fruits, and lean protein
  • not smoking

Importance of diabetes eye exams

Annual eye exams are recommended for people with diabetes.

During an eye exam, your eye doctor will dilate, or widen, your pupils with special drops so they can see the inside of your eye and look for any signs of developing damage.

Your doctor may also want to do optical coherence tomography (OCT) to monitor your retina and macula.

If the disease looks like it’s progressing, your doctor can discuss potential treatment options with you.

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Frequently asked questions that people with diabetes have about non-proliferative diabetic retinopathy include:

Can you have non-proliferative diabetic retinopathy with macular edema?

Yes, macular edema may be present with non-proliferative diabetic retinopathy in the mild, moderate, or severe versions.

Can you reverse non-proliferative diabetic retinopathy?

Research suggests the earliest stages of diabetic retinopathy can be reversed if you can maintain healthy blood sugar levels.

What is the ICD code for non-proliferative retinopathy?

The International Classification of Diseases, 10th revision (ICD-10) codes for non-proliferative retinopathy vary depending on whether it’s mild, moderate, or severe, and whether it involves macular edema.

The codes also vary based on whether you have type 1 or type 2 diabetes and which eye is affected.

The American Academy of Ophthalmology maintains a chart you can consult.

Diabetic retinopathy can impair your vision. The risk for it increases the longer you have diabetes.

You can take steps to reduce your risk, such as maintaining healthy blood sugar levels and getting regular eye exams.

Non-proliferative diabetic retinopathy may not produce any symptoms that you would notice, which further underscores the importance of preventive action.