Identification of the pre-proliferative diabetic eye

The rationale for early identification of the stage of diabetic retinopathy immediately preceding development of fibrovascular proliferation is that early diagnosis affords the opportunity to treat by photocoagulation or other methods at the appropriate stage of retinal disease. Aids to identification include: venous abnormalities, intraretinal microvascular abnormalities, "cotton-wool" spots and fluorescein angiographic evidence of capillary non-perfusion. Although no one of these fundus changes is specific for the pre-proliferative stage of diabetic retinopathy, the presence of more than one of these findings increases the risk of subsequent fibrovascular proliferation. The development of frank proliferation frequently occurs within two years of first appearance of the preproliferative stage.