The Four Stages Of Diabetic Retinopathy

diabetic retinopathy stages

Diabetes is a widely recognized disease; its most common subsequent health risks are well-known to the public. However, diabetic retinopathy, an eye disease unique to diabetics, is not as well-recognized as other diabetic complications. This leads to many cases of preventable blindness.  

Diabetes Infographic

Source: Centers for Disease Control (

Nearly all patients with diabetes will eventually develop some form of diabetic retinopathy within 15-20 years. The disease has four main stages and if it’s detected in the earlier stages, it is more easily treatable.

According to the American Academy of Ophthalmology, diabetic retinopathy is an eye disease that occurs when high blood sugar levels cause damage to blood vessels in the retina. The affected blood vessels can sometimes swell and leak, or they can close altogether, which causes a blockage and prevents blood from passing through.

Early detection is vital to a patient’s eye health and necessary to prevent the most severe stages of diabetic retinopathy. The ability to efficiently and effectively detect the disease makes an immense difference since most of the vision loss can be prevented with early diagnosis and appropriate treatment. Below is a look at the stages of diabetic retinopathy, how each stage manifests itself, and what medical solutions exist to prevent this from occurring.

Who is at risk for diabetic retinopathy?

Anyone with diabetes, whether it’s type 1, type 2, or gestational, can develop diabetic retinopathy. The better a patient controls their blood sugar, the less risk there is. But the longer a patient has diabetes, the more likely it is to occur. The early diabetic retinopathy stages are the best time to detect and treat the disease, which means that both diabetic patients and healthcare providers alike should take advantage of retinal imaging that catches the disease in its earliest stages.

Researchers have found that nonproliferative diabetic retinopathy (NPDR) was present in 25% of patients 5 years after they were diagnosed with diabetes, 60% at 10 years, and 80% at 15 years. These studies also found that the incidence of proliferative diabetic retinopathy (PDR) varied from 2% in those who had diabetes for less than 5 years to 15.5% in those who had diabetes for 15 or more years. 

While diabetic retinopathy is a common risk all diabetic patients face, technological advancements in the medical field have now made retinal screenings more accessible, which in turn will help to shorten diagnoses timelines and help provide better quality care. Taking precautionary measures to put an end to preventable blindness should be top-of-mind for both providers and patients.  

The Four Stages of Diabetic Retinopathy

The four diabetic retinopathy stages are classified as mild, moderate, and severe nonproliferative and proliferative. 

Baseline – No Diabetic Retinopathy is found: Non-proliferative diabetic retinopathy (NPDR)

normal fundus

Normal Fundus

1. Mild NPDR



The first of the diabetic retinopathy stages is characterized by a balloon-like swelling in certain areas of the blood vessels in the retina called microaneurysms. This stage rarely affects vision or needs treatment, but it does signal diabetes damage has occurred and an increased risk of disease progression.

At this stage, the patient must become educated on the possible ramifications of diabetes, while taking steps to better control their blood sugar and diet and decrease the risk of diabetic retinopathy progression and vision loss. Entities like health systems, health risk assessment companies, and insurance payors should ensure that patients are getting regularly tested for the presence of diabetic retinopathy to catch it as early as possible. Preventative screenings performed by healthcare professionals during in-home health evaluations or in primary care visits are excellent ways to catch diabetic retinopathy as early as possible in a way that saves money and patient time.

2. Moderate NPDR

Moderate NPDR

Moderate NPDR

The next diabetic retinopathy stage is characterized by damage to some of the blood vessels in the retina, resulting in leakage of blood and fluid into the retina tissue. This fluid can cause a loss of vision. 

 The use of fundus photography during a retinal screening, either as a part of an in-home evaluation or at a healthcare organization, can allow patients to receive a quick and accurate evaluation. When needed, referral to a specialist for further evaluation and possible treatment may be appropriate and recommended. Better control of blood sugar and obtaining further evaluation are key to potentially improving and ultimately saving the patient’s sight.

3. Severe NPDR

Severe NPDR

Severe NPDR

If there is continued inadequate control of diabetes, more blood vessels are damaged and blocked with even more leakage of blood and fluid into the retina, resulting in a much greater impact on vision. At this stage, a timely referral to an eye specialist is nearly always appropriate. The good news is that often, some, if not all, of the lost vision can be improved with appropriate treatment.

4. Proliferative Diabetic Retinopathy

Proliferative Diabetic Retinopathy

Proliferative Diabetic Retinopathy

The final stage of Diabetic Retinopathy is Proliferative Diabetic Retinopathy. At this point, the disease has advanced significantly and is very threatening to one’s vision. Because of additional damage to the eye’s blood vessels, there is worsening circulation inside the eye. In response, the retina then grows new blood vessels; however, they are abnormal and can cause severe damage, possibly resulting in vision loss and potentially blindness.

At this stage, patients require immediate referral to a retina specialist for further examination and treatment.

How do you ensure early detection of diabetic retinopathy?

Taking proactive steps to prioritize one’s eye care by scheduling annual diabetic retinal evaluations as recommended by the American Diabetes Association is vital to both detect and treat the earliest stages of diabetic retinopathy.

These crucial retinal evaluations can detect damage prior to any perceived deterioration in a patient’s vision, while also providing the opportunity to develop a treatment plan of action. This action plan can then provide a guideline for both patients and providers, ensuring a holistic understanding and treatment of how a patient’s diabetes is affecting their overall health. 

As healthcare providers consider the advantages of offering diabetic retinopathy exams to diabetic patients, solutions such as IRIS’s provide an improved experience for both the patients and providers by streamlining the exam and diagnosis process, creating easier access to quality care. The IRIS solution can help with the early detection of Diabetic Retinopathy stages for any healthcare or in-home evaluation organization, creating a simple process for providers while offering solutions for patients to stay on top of their eye health. IRIS’s solution helps providers and patients stay ahead of the curve in treating and preventing further development to advanced stages of diabetic retinopathy.

The IRIS solution is simple to use and can be integrated with nearly any EMR system. After the image is taken using a retinal camera, the image is sent electronically to the IRIS Reading Center, where licensed and experienced eye care professionals can accurately grade the images and the diagnoses are quickly sent straight back to a provider’s EMR. With this convenient, quick, and non-invasive eye exam, providers can help close care gaps by ensuring both patients and providers have the needed information to create an effective actionable care plan.

When the earliest stages of Diabetic Retinopathy are detected, healthcare providers can work with patients to better control their diabetes and slow the progression of the disease and decrease the chance of vision loss. The IRIS solution makes it easier for healthcare practices to provide annual diabetic retinopathy screenings with proprietary software that enhances fundus imagery allowing interpreting providers to easier see and diagnose pathology. The IRIS solution integrates with nearly any retinal camera and existing EMR workflow to make the implementation of the software as seamless as possible.

IRIS offers comprehensive onsite or virtual training for all staff in non-eyecare settings to make it easy to get up and running. Contact us to find out more and to aid in the efforts of limiting the negative effects of diabetic retinopathy.

The IRIS Solution for In-Home Evaluations

IRIS serves healthcare providers by offering an easy-to-use preventative screening measure that can be integrated into any healthcare organization’s workflow, but our solution is also ideal for in-home evaluation providers looking to improve their preventive screening measures. The IRIS solution helps insurance payors and in-home healthcare providers meet diabetic patients where they are in their health journey and close gaps in patient care more effectively and efficiently. 

The IRIS solution is one of the best ways insurance payors and other organizations who leverage health risk assessments (HRAs) can offer a preventative screening exam for diabetic retinopathy as a part of their in-home screening procedures. Improved quality of care, especially in the home setting, can lead to lower overall costs and a positive change in HEDIS/Star compliance.

Reach out today to see how IRIS can improve your patient care.



SM066 Rev. B

Get started with IRIS today.

Want to know if IRIS is right for you? Schedule a one-on-one consultation with our team. We’re here to help.