Purpose: To describe whether quantitative assessment of early changes in the m orphology of retinopathy lesions can predict development of vision-threatening diabetic maculopathy. Methods: We used a nested case-control study, and we stud ied 11 type 2 diabetes patients who had developed visual loss secondary to diabe tic maculopathy. For each diabetes patient, we also studied three matched contro l patients who had been followed for a comparable period of time without develop ing visual loss. Fundus photographs describing the early development of retinopa thy were digitized and subjected to a full manual quantitative grading on a comp uter monitor. Differences in the early development of retinal morphology were co mpared between the two groups. The outcome parameters were changes in the number and area of haemorrhages and exudates in different regions of the fundus, and t he weighted distance of these lesions from the fovea and the optic disc. Results : In patients who developed visual loss secondary to diabetic maculopathy there was significant early progression in the total area and number of haemorrhages a nd exudates. The haemorrhages had progressed in all retinal areas except the area around th e optic disc and the temporal vascular arcades. The exudates had progressed temp orally from the fovea and in the retinal periphery. Conclusions: The results sug gest that a quantitative description of the regional development of early diabet ic retinopathy may help in identifying patients who will later develop vision-t hreatening maculopathy. Purpose: To describe whether quantitative assessment of early changes in the m orphology of retinopathy lesions can predict development of vision-threatening diabetic maculopathy. Methods: We used a nested case-control study, and we studied 11 type 2 diabetes patients who had developed visual loss secondary to diabe tic maculopathy. For each diabetes patient, we also studied three matched contro l patients who had been followed for a comparable period of time without develop ing visual loss. Fundus photographs describing the early development of retinopathy thy were digitized and to a full manual quantitative grading on a comp uter monitor. Differences in the early development of retinal morphology were co mpared between the two groups. The outcome parameters were changes in the number and area of ​​haemorrhages and exudates in different regions of the fundus, and t he weighted distance of these lesions from the fovea and the optic disc loss secondary to diabetic maculopathy there was significant early progression in the total area and number of haemorrhages a nd exudates. The haemorrhages had progressed in all retinal areas except the area around th e optic disc and the temporal vascular arcades. The exudates had prog prog temp temp orally from the fovea and in the retinal periphery. Conclusions: The results sug gest that a quantitative description of the regional development of early diabet ic retinopathy may help in identifying patients who will later develop vision-t hreatening maculopathy.