Which finding would you expect in proliferative diabetic retinopathy?

• A. Macular edema
• B. Drusen
• C. Neovascularization
• D. Retinal detachment

Answer: (C)

Proliferative diabetic retinopathy is defined by growth of new, abnormal retinal vessels in response to retinal ischemia. These neovascular vessels develop on the retina and optic disc, driven by VEGF, and are fragile, prone to leakage or bleeding, and can form fibrovascular membranes that contract. This neovascularization is the key sign that distinguishes the proliferative stage from nonproliferative disease, making it the most characteristic finding. Macular edema can occur in diabetes but isn’t exclusive to the proliferative form; drusen are associated with age-related macular degeneration; retinal detachment can happen as a complication (often tractional) but isn’t the defining feature of proliferative retinopathy.