Retinopathy, or damage to the retina, is most often caused by poorly-controlled diabetes or premature birth. In nonproliferative diabetic retinopathy (NPDR), retinopathy symptoms may include hemorrhage, fluid leak into the retina, and blocked or enlarged blood vessels. The more severe proliferative diabetic retinopathy (PDR) symptoms are usually floaters in the visual field, shadows, blurred vision, spotty vision loss, or poor night vision. Retinopathy of prematurity (ROP) may afflict premature infants weighing less than 2.75 pounds (about 1.25 kg) or babies who are born before the 31st week of pregnancy. ROP symptoms are caused by blood vessels that develop abnormally; severity ranges from mild with few symptoms to severe with retinal detachment.
In early NPDR, people may not notice any retinopathy symptoms until damage is already done to the eye. As the disease progresses, the blood vessel walls in the retina become weak and begin to bulge, or form microaneurysms. Sometimes these areas of microaneurysms leak blood or fluid into the retina, which can cause blurred vision. If let untreated, the disease may progress to the point that the larger blood vessels dilate irregularly, the smaller vessels completely close, and the retinal nerves begin to swell. If someone has retinopathy symptoms, an ophthalmologist or optometrist can dilate the eye during a screening exam and quickly check the retina for any signs of retinopathy.
Blood vessels have already begun to grow in the retina when the disease has progressed to the more severe PDR. Blood may leak into the center of the eye, causing floaters or dark spots. Scar tissue may develop, which can potentially lead to a detached retina. Retinal detachment may cause vision loss, spotty loss of vision, or flashes of light. Glaucoma may occur if fluid cannot leave the eyeball and pressure builds up, damaging the optic nerve.
ROP is the leading cause of visual impairment and blindness amongst children. Both eyes are usually affected. There are five stages of the disorder, each with its own set of retinopathy symptoms.
Most babies have stage one or stage two ROP. In stage one or two, the blood vessel growth is mild-to-moderately abnormal. At both of these stages, special treatment is not usually required and the ROP resolves by itself. Vision is generally not impacted long term.
When blood vessel growth is severely abnormal, ROP has reached stage three. Stage three indicates that the disease is progressing. Instead of growing normally on the retinal surface, twisted, abnormal blood vessels begin to grow toward the eye's center. The majority of stage three babies require special treatment to avoid vision impairment.
By the time ROP has reached stage four, the main retinopathy symptoms are bleeding and the resulting scar tissue buildup. The scars begin to pull the retina off the eye wall, and treatment is necessary to prevent the condition from developing into stage five, at which point the retina will become detached. If the retina is not repaired once it has been pulled from the eye wall, significant visual impairment or total blindness can result.