Which statement best describes proliferative retinopathy?

• A. Hemorrhages only
• B. Neovascularization and scar formation
• C. Macular edema only
• D. Cotton-wool spots

Answer: (B)

Proliferative retinopathy is defined by the growth of new retinal vessels (neovascularization) driven by retinal ischemia, followed by scar tissue formation from fibrovascular membranes. These fragile new vessels can bleed into the vitreous and the scar can contract, pulling on the retina and risking tractional retinal detachment. That combination of neovascularization with subsequent scar formation is what sets proliferative retinopathy apart. Hemorrhages, cotton-wool spots, or macular edema can appear in other stages or aspects of diabetic retinopathy, but they don’t define the proliferative phase the way neovascularization plus scar formation does.