Diabetic retinopathy (DR) has been identified as a leading cause of blindness. One type of lesion, neovascularization (NV), indicates that the disease has entered a vision-threatening phase. Early detection of NV is thus clinically significant. Efforts have been devoted to use computer-aided analyses of digital retina images to detect DR. However, developing reliable NV detection algorithms requires large numbers of digital retinal images to test and refine approaches. Computer simulation of NV offers the potential of developing lesion detection algorithms without the need for large image databases of real pathology. In this paper, we propose a systematic approach to simulating NV. Specifically, we propose two algorithms based on fractal models to simulate the main structure of NV and an adaptive color generation method to assign photorealistic pixel values to the structure. Moreover, we develop an interactive system that provides instant visual feedback to support NV simulation guided by an ophthalmologist. This enables us to combine the low level algorithms with high-level human feedback to simulate realistic lesions. Experiments suggest that our method is able to produce simulated NVs that are indistinguishable from real lesions.