What Is Non-Proliferative Diabetic Retinopathy?

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Non-proliferative diabetic retinopathy (NPDR) includes the early stages of diabetes-related eye disease. It can become progressively worse, but you can take steps to slow the progression.

This article will highlight the stages of non-proliferative diabetic retinopathy, discuss the causes, consider what's involved with diagnosis and treatment, and examine the prognosis.

Person undergoing an eye exam for diabetic retinopathy

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Stages of NPDR

With NPDR, you may be in one of three stages. Here's what to know about each:

Stage 1: Mild

In this stage, there may just be a few microaneurysms (small bulges in blood vessels). They may leak a tiny bit while the rest of the eye is unaffected.

 Stage 2: Moderate

In this stage, the ophthalmologist (eye doctor) will find more microaneurysms and discuss whether you have dot-blot hemorrhages (areas of bleeding in the light-sensitive retina).

The ophthalmologist may also see fluffy white spots, known as cotton wool spots, and possibly some hard exudates made of lipids and protein that can leak out of blood vessels onto the retina.

Stage 3: Severe

At this stage, all four quadrants of the eye have retinal hemorrhages and microaneurysms. In at least two of the quadrants, some of the blood vessels may shut down, keeping the retina from getting enough blood supply. There may also be some retinal blood vessel abnormalities in at least one quadrant.


The root of non-proliferative diabetic retinopathy is damage to retinal blood vessels caused by out-of-control blood sugar levels. In non-proliferative diabetic retinopathy, these blood vessels can swell and leak fluid onto the light-sensitive retina.


An eye exam for non-proliferative diabetic retinopathy may begin with your ophthalmologist testing your vision and performing tonometry to check the pressure of the eye.

The ophthalmologist will then widen (dilate) the pupils to examine the inside of your eye and get a close-up view of the retina.

The ophthalmologist may also perform fluorescein angiography. This test injects some fluorescein dye into a vein, usually in the arm. This dye will travel up to the blood vessels of the eye, where blood flow in the retina can be photographed with a special camera.

Also, retinal imaging can be done with optical coherence tomography (OCT). This uses light rays to create pictures of the retina and help evaluate whether there's any fluid accumulation behind the retina.


Treatment options for non-proliferative retinopathy include:

  • Steroid injection: If you have macular edema (fluid in the macula area of the retina) this can help to reduce the amount of fluid leaking into the retina. To maximize this effect, steroid injections should be combined with laser treatment.
  • Laser treatment: In non-proliferative diabetic retinopathy, a laser (a device that emits light at certain wavelengths) is used to seal any leaking blood vessels.
  • Anti-vascular endothelial growth factor (VEGF) treatment: If macular edema is present, the Food and Drug Administration (FDA)–approved anti-VEGF agent Lucentis (ranibizumab) can be prescribed to treat it. Other anti-VEGF agents include Avastin (bevacizumab) and Eylea (aflibercept).


Diabetic retinopathy is a progressive disease. While you might not be able to prevent progression entirely, there's a lot you can do to slow it. Some ways you can help to keep retinopathy from progressing include:

  • Keep blood sugar levels low with a balanced diet.
  • Regularly test blood sugar and hemoglobin A1C levels to make sure these are low.
  • Exercise regularly to reduce blood sugar.
  • Use insulin that has been prescribed to you.
  • Strictly adhere to your ophthalmologist's treatment plan.
  • Have your eyes examined regularly for retinopathy.

These steps may help to lessen the need for treatment for more severe retinopathy, and they may also help to preserve vision.


Non-proliferative diabetic retinopathy is the earliest stage of diabetic retinopathy. It may initially be marked by a limited number of microaneurysms in the blood vessels that bulge and begin to leak.

By the severe, non-proliferative stage, these microaneurysms have developed throughout the eye, and the blood supply to the retina in at least part of the eye has begun to shut down.

The damage to the blood vessels results from out-of-control sugar levels that cause the vessels to swell and leak. Treatment can include steroid injections together with laser treatment to help seal leaky blood vessels. Also, in cases of macular edema, anti-VEGF injections may help.

If you keep blood sugar levels down with diet and exercise and adhere to needed treatment, you may slow the progression of diabetic retinopathy.

A Word From Verywell

If you have non-proliferative diabetic retinopathy, you have the earliest form of the disease. While diabetic retinopathy is a progressive condition, keeping your blood sugar in check and following your treatment plan can go a long way in slowing progression and preserving vision for longer.

Frequently Asked Questions

  • If my vision is fine, can I still have diabetic retinopathy?

    Yes, even with 20/20 vision you can still have diabetic retinopathy. Early signs of non-proliferative diabetic retinopathy can only be detected by widening your pupil and looking inside the eye for tiny changes. Such changes are too small to impact vision.

  • Is non-proliferative diabetic retinopathy reversible?

    Unfortunately, this is an irreversible condition. Once the blood vessels are damaged, lowering blood sugar will not repair them. But reducing blood sugar levels may keep other blood vessels from becoming damaged and slow progression.

  • Can you drive with non-proliferative diabetic retinopathy?

    Yes. This is the early form of diabetic retinopathy, and particularly in mild and moderate cases, the retina may not yet be affected. This means you may still have 20/20 acuity even though you have diabetic retinopathy.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Ophthalmology. Diabetic retinopathy.

  2. Stanford Medicine. What causes diabetic retinopathy.

  3. Stanford Medicine. Diabetic retinopathy diagnosis.

  4. Johns Hopkins Medicine. Diabetic retinopathy.

  5. American Diabetes Association. Vision loss and diabetes.

  6. National Eye Institute. Diabetic retinopathy.

By Maxine Lipner
Maxine Lipner is a long-time health and medical writer with over 30 years of experience covering ophthalmology, oncology, and general health and wellness.