Diabetic retinopathy is a vision-stealing effect of diabetes. What causes diabetes, and how can you prevent it? Can diabetic patients prevent this eye disease? What can you do to halt diabetic retinopathy? How can patients preserve their vision?
Step 1: Don’t Get Diabetes
Avoiding Type 1 Diabetes is a virtual impossibility. Doctors do not know why the immune system attacks the pancreas. The underlying cause is typically genetic, but a trigger also seems to be needed. Type 1 is usually diagnosed in childhood and represents less than 10% of diabetic cases.
Type 2 Diabetes is avoidable in many cases. A sedentary lifestyle, poor diet, and excess weight are important risk factors. Type 2 used to be called “adult-onset,” however, overweight children are also being diagnosed. Too many calories, excessive refined carbohydrates, and lack of exercise affect all age groups. Blood sugar levels become unstable: too high, too low, and fluctuating too much. This leads to insulin resistance. The body cannot use insulin effectively. Other risk factors include genetics, high blood pressure, and abnormal cholesterol and triglyceride levels.
Diabetic retinopathy affects more than 40% of diabetic patients by some estimates.
Step 2: Control Blood Sugar
About a third of adults who have diabetes don’t know it. Your doctor should check your blood sugar levels regularly. The hemoglobin A1c measures average blood sugar over the last few months. If the doctor suspects a problem, he or she may order additional tests, such as a glucose tolerance test. A diagnosis of pre-diabetes is a message: follow the instructions in Step 1 above to reverse the condition.
If you have a diagnosis of diabetes, your health and longevity depend heavily on controlling blood sugar levels. Work closely with your doctor to manage the condition.
The good news about Type 2 diabetes is that in many cases, it can be reversed. Start a regular exercise program. Avoid crash diets and fad diets. Instead, transition to a nutrition plan with fewer processed foods and more whole foods such as the Ketone Diet or South Street Diet. Consult with your doctor before making any changes. Whole foods and high-fiber foods will help you feel fuller. The Mediterranean Diet is very helpful for preventing and supporting Type 2 diabetes.1 Your dietitian can develop meal plans based on the Mediterranean Diet.
This diet also supports vision health. Since the eyes require high amounts of essential nutrients, nutrient-rich foods automatically support the eye’s delicate structures. For example, oily fish like salmon are high in omega-3 fatty acids, which fights diabetic retinopathy. Many fruits and vegetables contain carotenoids that reduce free radical damage associated with diabetic retinopathy.
Poorly controlled diabetes can also lead to cardiovascular disease, nerve damage, kidney damage, amputations, skin conditions, hearing difficulties, Alzheimer’s disease, and depression. Diabetes can also damage the blood vessels in the retina. Cataracts and glaucoma are more common among diabetic patients.2
Step 3: Get Eye Exams
People with diabetes need a dilated eye exam every 1 to 2 years. A superficial prescription check by an optician is not enough. The doctor typically will put in drops to dilate your pupils. He or she will examine the retina using a special lamp and take an OCT scan of the retina.
By the time a person experiences symptoms of diabetic retinopathy, the disease is well underway. Do not wait for symptoms, which may include:
- blurred vision when blood sugar is high
- dark floaters
- empty or dark areas of vision
- color vision impairment
- vision fluctuations
- vision loss
The primary cause of diabetic retinopathy is high blood sugar. Other risk factors for diabetic patients include depression, low levels of nutrients in the blood (vitamin C, vitamin D, magnesium, folic acid), kidney disease, inflammation, and high homocysteine levels.3
Ideally, the eye doctor will detect diabetic retinopathy in an early stage. Not everyone goes through all these stages in order:
- Mild non-proliferative: retinal capillaries swell and leak
- Moderate non-proliferative: some retinal capillaries are blocked, depriving the retina of nutrients
- Severe non-proliferative: too many capillaries are blocked, leading to neovascularization (new, abnormal growth of blood vessels in a desperate attempt to bring in nutrients). The new blood vessels are fragile and tend to leak, causing significant vision loss if untreated. Nerve fibers may also be damaged (looking like “cotton wool”).
- Proliferative: new capillaries grow in and on the retina, reaching into the vitreous or white of the eye. These fragile capillaries are very likely to leak.
Diabetic retinopathy has several treatments that slow down or mitigate the effects of the disease.
Step 4: Basic Diabetic Retinopathy Care
Listen closely to your doctors. The first line of defense is to control blood sugar tightly. Discuss your vision diagnosis with the doctor who helps you manage your diabetes. You may need more support or advanced technology that constantly regulates blood sugar levels.
Inflammation, poor circulation, and inadequate nutrition are all linked to poor vision health. These lifestyle choices can reduce your risk of developing many types of eye disease, including diabetic retinopathy:
- Manage your blood pressure. High blood pressure (hypertension) is especially detrimental to diabetic retinopathy patients.
- Avoid AGEs, found in foods that are fried, grilled, seared, or roasted at a high temperature. AGEs are also prevalent in butter, cream cheese, mayonnaise, and high-fat, aged cheese. These compounds cause significant oxidation in the body. The eyes are particularly vulnerable to free-radical damage.
- Don’t smoke. Smoking restricts blood flow to the eyes and causes oxidization.
- Eat an anti-inflammatory diet. Chronic, systemic inflammation is linked to many diseases, including eye disease. Processed foods, refined carbohydrates, and sugar increase inflammation. Our Vision Diet is an anti-inflammatory diet and a variation on the Mediterranean Diet.
- Get your daily dose of exercise. Even a half hour walk each day is a start. Avoid any sport that could cause retinal bleeding.
- Daily eye exercises may help. Diabetic retinopathy patients should especially do palming and eye massage according to these directions.
Step 5: Take Targeted Nutrients
In addition to a healthy diet, consider adding targeted nutrients for the eyes. The causes of Type 2 diabetes and diabetic retinopathy are fairly well researched. Research into nutrients has revealed:
- Antioxidants can reduce inflammation associated with diabetes (alpha-lipoic acid, CoQ10, ginkgo biloba4, lutein/zeaxanthin/lycopene, glutathione, taurine, resveratrol, etc.) and diabetic eye disease
- Certain foods and supplements address neovascularization and blood vessels (bilberry, dark, green leafy vegetables, ginger, garlic, cabbage, etc.). Many people should avoid nightshades, which include tomatoes, eggplant, peppers, potatoes, tomatillos, goji berries.
- Deficiencies are associated with diabetes (Vitamin D5) and diabetic retinopathy (lutein/zeaxanthin/lycopene)
Taking a single, isolated nutrient may have little impact on complicated diseases such as diabetes or diabetic retinopathy. At Natural Eye Care, we have developed a Sugar Balance & Blood Vessel Support Package. These supplements include the most important spectrum of nutrients aimed at supporting diabetes and diabetic eye disease.
Step 6: Advanced Diabetic Retinopathy Treatments
The doctor may offer treatments for more serious cases of diabetic retinopathy, especially for the proliferative forms. However, they sometimes have potential side effects and may lead to further surgeries.
Anti-VEGF Injections: A treatment for both macular degeneration and diabetic retinopathy, Anti-Vascular Endothelial Growth Factor injections reduce retinal bleeding or swelling. They also shrink new blood vessels. The drug is injected directly into the eye and must be repeated. The effects wear off over time. Brand names include Lucentis, Avestin, Regeneron, and Eylea.
Laser Surgery: The eye surgeon zaps the eye with a laser to seal or shrink blood vessels. Lasers can only preserve vision, not make it better. The treatment can result in peripheral vision loss.
Vitrectomy: The eyeball gets its shape from the vitreous gel inside. If retinopathy is advanced, blood vessels grow into the vitreous. To do laser surgery, the doctor needs to move these blood vessels out of the way. The doctor removes the vitreous and replaces it with saline or gases. The patient must use a regimen of eye drops afterwards. The body replenishes the vitreous fluid, clearing the way for laser surgery. However, vitrectomy has many risks and potential side-effects.
Most diabetic retinopathy cases are preventable. A healthy weight and lifestyle usually prevent the conditions leading to Type 2 diabetes. High blood sugar levels damage the retina and trigger cascading vision failure. High-tech treatments for advanced diabetic retinopathy carry significant risks. Therefore, prevention is key. If you have diabetes, manage your blood sugar, take targeted nutrients, manage hypertension, eat a healthy diet, and get daily exercise.
- Rationale for the Use of a Mediterranean Diet in Diabetes Management. Gretchen Benson, RD, LD, CDE, Raquel Franzini Pereira, MS, RD, LD and Jackie L. Boucher, MS, RD, LD, CDE. Diabetes Spectrum 2011 Feb; 24(1): 36-40. https://doi.org/10.2337/diaspect.24.1.36 ↩
- https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444 ↩
- Natural Eye Care: Your Guide to Healthy Vision and Healing, 2nd Ed. By Marc Grossman, O.D. L.Ac. and Michael Edson, L.Ac. Edited by Jennifer W. Miller. Pages 354-355. 2018. ISBN: 978-0-692-07431-2 ↩
- Lanthony P, Cosson JP. Evolution of color vision in diabetic retinopathy treated by extract of Ginkgo biloba. Journal For Ophthalmology 1988;11:671-74 in French ↩
- N. Alcubierre, J. Valls, E. Rubinat, G. Cao, A. Esquerda, A. Traveset, M. Granado-Casas, C. Jurjo, and D. Mauricio. Published: Vitamin D Deficiency Is Associated with the Presence and Severity of Diabetic Retinopathy in Type 2 Diabetes Mellitus, Journal of Diabetes Research. May, 2015 ↩