Proliferative diabetic retinopathy causes visual loss in the following ways:

Vitreous hemorrhage:
When there are new blood vessels growing on the retina, sometimes they may bleed into the vitreous (the clear, gel-like substance that fills the eye). If the vitreous hemorrhage is small, a person might see only a few new, dark floaters. A very large hemorrhage might block out all vision.

It may take days, months, or even years to reabsorb the blood, depending on the amount present. If the eye does not clear the vitreous blood adequately within a reasonable time, vitrectomy surgery may be recommended.

Vitreous hemorrhage alone does not cause permanent vision loss. When the blood clears, vision may return to its former level unless the macula is damaged.

Traction retinal detachment:
When PDR is present, scar tissue associated with neovascularization can shrink, wrinkling and pulling the retina from its normal position. Macular wrinkling can cause visual distortion. More severe vision loss can occur if the macula or large areas of the retina are detached.

Neovascular glaucoma:
Occasionally, extensive retinal vessel closure will cause new, abnormal blood vessels to grow on the iris and in the drainage channels in the front of the eye. This can block the normal flow of fluid out of the eye. Pressure in the eye builds up, resulting in neovascular glaucoma, a severe eye disease that causes damage to the optic nerve.

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