Background diabetic retinopathy (mild none-proliferative retinopathy)

David Kinshuck



background diabetic retinopathy...dot and blotsenlarge  This is the view a doctor sees looking into your eye. The small red dots are 'microaneurysms', tiny damaged capillaries.

The bigger red blobs are small haemorrhages, little flecks of blood. The white dots are exudates (leakage). Your sight is not affected at this stage.This is the term given to early damage of the retina in diabetes. Your sight should be perfectly good at this stage. A doctor examining your eye will notice tiny abnormalities.


The tiny blood vessels in the retina, the capillaries, become damaged, from the diabetes.

Blood vessel damage is generally visible on photographs. In the UK, nearly every person with diabetes should have yearly photos taken. In Birmingham these are taken by about 40 optometrists across the city, but in other places technicians take the photos, often with mobile cameras.

The photographs are examined by the optometrist or photographer, (or computer), and patients with significant damage are referred to hospital clinics. Your pupils have to be dilated  for this examination, and you are often advised not to drive until the pupils have returned to their normal size. See


What the doctor sees

A doctor or optometrist may see 'dots' and 'blots'. The dots are some capillaries that have enlarged, that is the the tiny blood vessels enlarge to form microaneruysms. See photo tour and photo and photo.  The blots are tiny haemorrhages, that is tiny spots of blood, on the surface of the retina. There are also leaky areas, called exudates. See photo


What does it mean if you have 'background retinopathy'?

The number of microaneurysms, the little red dots the doctor sees, indicate the likelihood of more severe problems in the years to come. See photo.  As the damage is mild at this stage, your sight will be nearly perfect. However, the condition does progress.

This condition is now often called mild none-proliferative retinopathy. If it gets worse the term  severe none-proliferative or preproliferative retinopathy is used.

It occasionally progresses quickly, but usually changes slowly. If your diabetes and blood pressure are well controlled, and have been all the time you have had diabetes, changes should be very slow (prevention) are controlled. Unfortunately for many people with diabetes the retinal damage increases, and maculopathy or proliferative retinopathy develop over a few years.

Background retinopathy generally means your diabetes is not controlled as well as it might be. If you have been diabetic 30 years, even with the best control, these may develop. But most people who have background retinopathy have not been diabetic that long, and need better control as per these targets.


Types & progression of background retinopathy

Retinopathy progression appears to follow different patterns. Some patients develop leakage (such as macular oedema), and others develop more severe capillary closure (which also causes loss of sight, see proliferative and pre-proliferative). See

The number of haemorrhages and microaneurysms indicate progression. If they increase in number the retinopathy is getting worse. Dropping blood pressure to the targets below will slow down progression right away.

But if there is significant retinopathy, it takes 3 years of low blood sugars (eg HbA1c <58mmol/l 7.5%, the lower the better) before good control helps.


Photo..circinate retinopathy

This photograph shows 'circinate' retinopathy. Laser treatment is needed (early maculopathy). Good diabetic control is needed. Circinates further from the macula would be classified as 'background' or early none-proliferative retinopathy.

circinate retinopathy...good control is needed to prevent serious eye problems in 3-5 years

Circinate retinopathy...good control is needed to prevent serious eye problems in 3-5 years. There is a circle of exudates surrounding a leaky area, with a dot haemorrhage or microaneurysm in the middle. (Case 54)


Once background retinopathy is discovered,


Remember the 'targets' for good control

By keeping to these levels as much as possible (or lower still) you will be doing your best to stop your eyes getting worse. Occasionally by sticking to these targets your retinopathy will improve, even without laser. Review BMJ17   



blood pressure


sudden decrease in HbA1c

cholesterol and statins




Diabetes education courses

sleep apnoea etc

glucose level






type 2 at diagnosis