The waxy accumulations are called hard exudates, shown in yellow in A. above. They cause scarring of the retina with vision loss to whatever regions they occur in. The goal in diagnosis of diabetic eye disease is to catch the disease before the waxy deposits accumulate near the fovea, and before swelling has caused much permanent vision loss. Fluid accumulation within the retina is shown in blue in B above. Scattered microaneurysms, shown as red dots, leak fluid.
Yellow exudate representing fats that like sludge remain behind is seen throughout.
Areas in which circulation is absent are found as well due to the plugging of capillary circulation that also occurs. Any vision lost from these two types of background diabetic damage is permanent. It is therefore imperative these problems be caught and treated early. Background retinopathy is aggravated by poor circulation, poorly controlled high blood pressure, and poor sugar control. Better vision screening methods are needed to detect early diabetic retinopathy, especially since it is painless and begins away from detectable central vision an average of ten years after diabetes is first diagnosed.