NPDR vs. PDR: A Comparison of Diabetic Retinopathy Types

If you have diabetes, you must arm yourself with answers to the following questions:

  • What is diabetic retinopathy?
  • What is the difference between nonproliferative and proliferative diabetic retinopathy?

Knowing the answers will help you recognize vision changes and seek appropriate treatment before it’s too late.


Understanding Diabetic Retinopathy: NPDR and PDR

Let’s start with the basics:

  • Diabetic retinopathy (DR) is a medical complication of diabetes.
  • Diabetes results from the pancreas failing to make enough insulin or the body struggling to use the insulin it produces.
  • Insulin is a hormone responsible for regulating blood glucose (sugar).
  • Uncontrolled high blood sugar eventually damages the small blood vessels inside the retina. Diabetic retinopathy characterizes this retinal damage, which can lead to vision problems and blindness.

Diabetic retinopathy rarely presents early warning signs. It also affects both eyes in most cases. People with diabetes do not realize they have DR until they experience vision changes or receive a shocking diagnosis from an eye care professional during a dilated eye exam.

Diabetic retinopathy has two main types: Nonproliferative diabetic retinopathy and proliferative diabetic retinopathy.


What Is Nonproliferative Diabetic Retinopathy?

NPDR refers to the early stages of diabetic retinopathy. In this early, nonproliferative phase, the following begins to form in the retina: 

  • Microaneurysms: Bulges or outpouchings in the blood vessels.
  • Hard exudates: Yellowish deposits that accumulate due to blood and fluid leakage from damaged blood vessels. They often occur in ocular conditions like diabetic retinopathy or macular degeneration. Hard exudates can impair vision if they gather near the center of the retina (macula).

These abnormalities cause little to no vision loss early on. However, although vision changes in NPDR are gradual, some symptoms can develop. These include blurred vision, difficulty seeing at night, and seeing spots or dark areas. Still, vision loss is not yet present in NPDR.

The main objective in treating NPDR is to control blood glucose, blood pressure, and cholesterol levels to slow progression into PDR. Lifestyle changes, like following a nutrient-dense diet, exercising, and not smoking, are highly recommended. Regular eye exams by a Sun City ophthalmologist can detect NPDR early, before vision symptoms develop. Early detection ensures treatment begins before vision loss occurs.


What Is Proliferative Diabetic Retinopathy?

As NPDR progresses, the blood vessels in the retina can close off, leak, or grow abnormally. This is the proliferative stage, where the lack of oxygen in the retina causes fragile, abnormal blood vessels to develop. These new blood vessels can bleed, leak fluid, and cause scarring, which can cause partial or complete vision loss. PDR demands immediate treatment with medications, laser therapy, or surgery to prevent vision impairment or even blindness.


Stages of Diabetic Retinopathy

Medical experts classify DR into four stages depending on progression. The four stages include:

  • Stage 1 – Mild NPDR: In this early stage of DR, a patient may not notice any symptoms. Its distinctive feature is the presence of at least one microaneurysm in the retina’s blood vessels, which a doctor can detect through a dilated eye exam.
  • Stage 2 — Moderate NPDR: As the retina’s blood vessels continue swelling, a patient may start noticing symptoms like cloudy vision. Arizona Retinal Specialists will be able to identify multiple microaneurysms in this stage.
  • Stage 3 — Severe NPDR: In this advanced stage, bleeding occurs in all four quadrants of the retina, venous beading emerges in two or more quadrants, and atypical branching of blood vessels occurs in one quadrant.
  • Stage 4 — PDR: Proliferative diabetic retinopathy is the most advanced stage. Its clinical features are the development of new, weak blood vessels in the retina or bleeding in the vitreous cavity. Symptoms include worsening vision, floaters, eye pain, eye redness, night blindness, and sudden vision loss.


How to Manage and Treat Diabetic Retinopathy

If you have diabetic retinopathy, the treatment plan will depend on your condition’s severity and progression. For NPDR, the main goal is to manage high blood sugar, blood pressure, and cholesterol to prevent further vision loss or slow progression. Strict control and monitoring of diabetes is critical.

You must follow your doctor’s recommendations closely regarding:

  • Blood sugar testing and maintaining target glucose levels
  • Following guidelines for using insulin and other diabetes medication
  • Eating a healthy, balanced diet
  • Exercising regularly
  • Not smoking
  • Practicing eye safety, such as wearing protective eyewear and giving the eyes a break from screen time
  • Checking your eyes regularly with dilated eye exams

More tips to slow down diabetic retinopathy progression.

For PDR, more aggressive treatment is necessary to prevent severe vision loss or blindness, as new blood vessels can bleed into the eye. Options include:

  • Laser treatment (photocoagulation) to stop new blood vessel growth and bleeding
  • Steroid injections to reduce inflammation
  • Injections with vascular endothelial growth factor (VEGF) inhibitors to block proteins that lead to new vessel formation
  • Surgery (vitrectomy) to repair damage from bleeding

Learn more about your treatment options for diabetic retinopathy.

Like all diseases, the earlier diabetic retinopathy is traced and treated, the better the chances of preserving vision. Close monitoring by an ophthalmologist near you is mandatory to detect recurrence or new vessel growth, as well as determine if additional treatment is necessary.

Living with diabetic retinopathy can be frustrating, but following the recommended management plan and available treatments can help slow or prevent significant vision loss. Also, never forget that you have the power to positively impact your eye health and quality of life, starting with controlling your diabetes. Consult your general practitioner about how to lower your blood sugar and blood pressure levels with diet, exercise, and medication.


Key Takeaways From Arizona Retinal Specialists

NDRP and PDR pose threats to vision and eye health. However, while NPDR impacts eyesight gradually, PDR rapidly progresses and can lead to blindness. Partner with your endocrinologist and ophthalmologist, adhere to treatment plans, and make healthy lifestyle choices. By committing to your health, you can preserve your vision for years to come.

Further reading: Don’t Go Blind: Importance of Diabetic Eye Exams in Sun City, AZ. You can also contact us at 623-474-3937 to schedule your eye appointment.

NOTICE TO USERS is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified health provider with any questions you may have regarding any health symptom or medical condition. Never disregard professional medical advice nor delay in seeking professional advice or treatment because of something you have read on