Specific changes to your eye’s blood vessels can indicate that you have an eye complication of diabetes that needs attention.

When you have diabetes, especially for a long time, high blood sugar levels can damage the blood vessels in your eyes and lead to an eye condition called diabetic retinopathy. This complication of diabetes worsens over time and can lead to vision loss.

Diabetic retinopathy has two primary stages. During the first stage, the tiny vessels in your eyes can change shape, swell, and leak, causing blurry vision and other problems. When that goes on too long, you can develop intraretinal microvascular abnormalities (IRMAs), the name for specific changes in the blood vessels.

IRMAs can indicate that diabetic retinopathy is getting worse or may be entering the second stage. Here’s what to know.

IRMAs are the stretching or deforming of the eye blood vessels as diabetic retinopathy progresses through the first stage, also called nonproliferative diabetic retinopathy.

IRMAs are one of the most evident signs that retinopathy has become more severe and is closer to the more advanced stage, known as proliferative diabetic retinopathy.

The more pronounced your IRMAs, the more likely this may be.

It can be hard to tell IRMAs from another disease process called neovascularization. Neovascularization happens during proliferative diabetic retinopathy, the more advanced stage.

The differences between them are:

  • size
  • location
  • arrangement
  • whether they’re leaky

IRMAs are larger than neovascularization and are located only in the intraretinal layers.

Neovascularization is thinner and may be concentrated in certain spots. The vessels in neovascularization may leak. IRMAs usually don’t leak.

Healthcare professionals may use special imaging to look at your blood vessels. They may use fluorescein angiography, also known as a dye test.

To do the test, a healthcare professional injects a fluorescent dye into your bloodstream to better examine the blood vessels in your eye and determine whether any are leaking.

They may also try optical coherence tomography angiography (OCT-A). It’s a noninvasive imaging technique that doesn’t involve dye.

Some healthcare professionals use the 4-2-1 rule to determine whether you have severe nonproliferative retinopathy. This is the stage before retinopathy progresses to the more advanced proliferative stage.

You may have severe nonproliferative retinopathy if your symptoms fit one of the general criteria:

  • microaneurysms, hemorrhages (bleeds), or both in all four retinal quadrants
  • venous beading, which means the walls of your eye’s vessels have abnormal constrictions, sometimes making them look like a string of sausages, in at least two quadrants
  • prominent IRMAs in at least one quadrant

Treating IRMAs begins with managing your diabetes. Blood sugar management is vital to keeping sugar from continuing to damage your eyes and other organs.

Diabetes management tips include:

  • checking your blood sugar regularly
  • managing stress
  • getting regular health checkups, including eye exams
  • taking all prescribed medication as directed by your doctor
  • exercising regularly
  • managing body weight, including losing weight if needed
  • quitting smoking, if applicable

Your healthcare team may recommend other treatments for diabetic retinopathy. They vary by stage and symptoms.

They include:

  • laser treatments
  • injections
  • surgery

Diabetic retinopathy is a common complication of diabetes. It could lead to vision loss, especially as it progresses. It’s the leading cause of blindness in working-age adults in Western countries. Symptoms and risk increase as it develops.

If you have IRMAs as a consequence of diabetic retinopathy, you may experience the following symptoms:

  • blurred vision
  • distorted vision
  • floaters
  • partial vision loss
  • total vision loss

The high blood sugar levels in diabetes can damage the blood vessels in your eyes. The damage can lead to intraretinal microvascular abnormalities (IRMAs), the name for specific blood vessel changes. The vessels become stretched out or grow where they shouldn’t.

IRMAs can be a sign of a more advanced form of diabetic retinopathy. This diabetes complication can cause vision problems, including vision loss, when untreated.

Consider consulting your healthcare team as soon as possible for diagnosis and treatment.