How does diabetic retinopathy typically progress?

• A. It starts as proliferative and then becomes non-proliferative
• B. It is unrelated to the duration of diabetes
• C. It resolves spontaneously in all cases
• D. It progresses from non-proliferative to proliferative over time

Answer: (D)

Diabetic retinopathy typically evolves from non-proliferative retinal changes to proliferative changes over time. In the early stage the retina shows microaneurysms, hemorrhages, and exudates from capillary damage. As ischemia progresses, the retina increases production of VEGF, driving the growth of fragile new vessels on the optic disc and retina—the proliferative phase. These new vessels can bleed into the vitreous and cause scarring that pulls on the retina, risking detachments and vision loss. It does not spontaneously resolve in all cases, and longer duration of diabetes (along with control of blood sugar, blood pressure, and lipids) raises the risk of progression. Treatments aim to prevent progression, such as laser therapy or anti-VEGF injections once proliferative changes develop, alongside ongoing metabolic control.