What could potentially lead to further visual impairment in proliferative retinopathy?

Scar tissue formation is a critical factor that can contribute to further visual impairment in proliferative retinopathy. In this condition, abnormal blood vessels grow on the retina, which can lead to bleeding and fluid leakage. As the disease progresses, scar tissue can form in the retina as a response to these complications. This scar tissue can contract and pull on the retina, potentially causing retinal detachment, which significantly worsens vision. Therefore, the presence of scar tissue exacerbates the already compromised retinopathy, leading to a greater risk of further visual impairment.

Other options, while they may have their own implications for eye health, do not directly relate to the mechanism of visual deterioration specific to proliferative retinopathy in the same way that scar tissue formation does.