Systemic complications of diabetes typically manifest clinically after permanent tissue damage has already occurred. Unlike the changes occurring in other organs, the microvascular alterations responsible for preventable vision loss can be observed directly through a dilated pupil (Fig. 1). Clinicians caring for diabetics should be skilled at recognizing the signs and symptoms of diabetic retinopathy, not only because it minimizes visual sequelae, but also because the status of the retina reflects microvascular complications occurring elsewhere in the body.
Ophthalmologists classify diabetic retinopathy as non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). The non-proliferative changes are also commonly referred to as background diabetic retinopathy. The ocular changes seen in eyes with NPDR all occur at the level of the retina, in contrast to PDR, which is characterized by the growth of blood vessels and fibrous tissue beyond the surface of the retina. The clinical
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