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Proliferative diabetic retinopathy is characterized by the growth of new blood vessels (neovascularization) in response to ischemic conditions within the retina. This stage occurs as a complication of DM and signifies that the condition has progressed beyond the earlier stages of diabetic retinopathy, which primarily involve microaneurysms and retinal thickening. The newly formed blood vessels are fragile and prone to leakage, leading to potential hemorrhages. This makes proliferative diabetic retinopathy a critical stage where significant sight-threatening changes occur, necessitating immediate medical intervention to prevent vision loss.

Other stages, such as severe, moderate, or mild nonproliferative diabetic retinopathy, do not involve neovascularization or the presence of significant hemorrhage. Instead, these stages are characterized by varying degrees of retinal edema, cotton wool spots, and microaneurysms, without the presence of the neovascular changes seen in proliferative retinopathy. Thus, the defining features of proliferative diabetic retinopathy are what clearly set it apart as the stage involving these serious retinal changes.