Diabetic retinopathy is an eye disease that can affect people with any form of diabetes: Type 1, Type 2 or gestational diabetes. The condition is caused when blood sugar and blood pressure in the tiny blood vessels in the eye “spring a leak” and release blood into the eye. This leads to blurry vision, seeing floaters or even complete vision loss in severe cases.
The tricky thing about diabetic retinopathy is that not everyone has symptoms right away. Many people may have some damage from this condition without realizing the cause, and still others may attribute the vision problem to something else, such as getting older. As many as 45 percent of the 29 million Americans with diabetes have some degree of diabetic retinopathy, and half of them may not even know it. (1, 2)
The good news is that people with diabetes can prevent or delay diabetic retinopathy through a variety of natural approaches. And if the disease does begin, there are natural ways to manage the condition and keep it from getting worse. The bad news? It requires long-term effort, since vision loss from this condition is a lifelong risk for people with diabetes.
What Is Diabetic Retinopathy?
To define diabetic retinopathy, you first have to understand diabetes. Diabetes is a disease in which the body has difficulty making or using sugar (glucose). This leads to periods of high or low blood sugar, which can make it hard for the rest of the body to function at times. In diabetic retinopathy, high blood sugar starts to damage the tiny blood vessels in the retina, which is part of the eye. The blood vessels may close or swell and leak. (3) The eye may also start to grow new blood vessels. These changes in blood vessel health eventually cause changes in vision. (4)
There are technically four stages of diabetic retinopathy. The first three stages of the disease fall into nonproliferative diabetic retinopathy (NPDR):
Mild nonproliferative diabetic retinopathy
In the first NPDR stage, called mild nonproliferative diabetic retinopathy, the tiny blood vessels in the eye start to swell here and there, and leak into the eye. (5) You may or may not notice any changes to your vision with these small leaks. When you have no symptoms, this stage is also called background diabetic retinopathy.
Moderate nonproliferative diabetic retinopathy
Once the blood vessels start swelling inside the eye, you have moderate nonproliferative diabetic retinopathy. (6) Blood vessels may start to lose their ability to transport blood at this stage. (7) When swelling affects the macula — a small area in the middle of the retina that helps you see details like words or faces — you can start to lose your vision. (8) This is called macular edema, and it’s the most common reason people with diabetes lose sight. (9)
Severe nonproliferative diabetic retinopathy
In severe nonproliferative diabetic retinopathy, the blood vessels in the retina start to close, keeping enough blood from reaching the macula. This is called macular ischemia and results in blurry vision. (10) Your eyes start to release the signal for your body to build new blood vessels in the area, which leads to the final stage of the disease. (11)
Over time, if early stages of the disease are not treated or prevented, the disease progresses to its most advanced stage: proliferative diabetic retinopathy (PDR).
Proliferative diabetic retinopathy
PDR is the most serious stage of the disease. You have proliferative diabetic retinopathy once the eye starts to grow new blood vessels. (12) Since these new vessels are delicate, they may bleed, causing you to see dark floaters. If they bleed too much, it can block your vision entirely. (13) The new blood vessels in PDR can also lead to the growth of scar tissue, which can cause other problems, such as a detached retina or problems with the macula. (14)
Diabetic retinopathy can cause partial or total blindness. An eye doctor can diagnose even early stages of the disease during an eye exam. Regular eye exams are crucial for people with diabetes.
Signs & Symptoms of Diabetic Retinopathy
In the early stages of the disease, you may have no symptoms. Diabetic retinopathy symptoms often start slowly, with occasional “floaters” in the vision. These floating spots may come and go or disappear altogether. Other people may notice blurry vision, such as difficulty reading or seeing faces as well as they could in the past. If these early signs and symptoms of diabetic retinopathy don’t get early treatment, they can lead to the permanent vision changes caused by late stages of the disease. (15)
As you progress through the stages, signs and symptoms may include:(16)
- Floaters (spots or strings)
- Dark spots or empty areas of vision
- Blurry vision
- Hazy vision
- Vision changes that come and go
- Trouble seeing colors
- Difficulty seeing at night
- Vision loss
In some cases, these symptoms can come on suddenly, including vision loss. (17) See an eye doctor every year (more often if you’re pregnant and have diabetes) to catch the signs of diabetic retinopathy early — possibly before you even start to notice symptoms.
Causes & Risk Factors
Diabetic retinopathy causes include having diabetes and having poor blood glucose control over time. People who do not have diabetes do not develop diabetic retinopathy, although they can experience many eye diseases (retinopathies) that have the same symptoms and effects.
Risk factors for diabetic retinopathy include: (18, 19, 20)
- Poor blood sugar control
- Diabetes (type 1 or type 2) during pregnancy
- Hispanic, black or American Indian/Alaska Native descent
- High blood pressure
- High cholesterol
- Older age
The longer you have had diabetes, the greater your risk of developing diabetic retinopathy. (21) This is part of the reason older adults are more likely to have diabetic eye diseases than younger people. Also, people are more likely to develop type 2 diabetes as they age. Among Hispanics, being 50 or older increases the risk of diabetic retinopathy, and this risk increases even more among people aged 75 years and older. (22) In fact, 19 percent of all U.S. Hispanics who are 75 and older have diabetic retinopathy. (23)
The types of conventional treatments your eye doctor suggests will depend on how advanced your diabetic retinopathy is and what types of damage are causing the problem. In very early diabetic retinopathy, it’s possible that no treatment will be given, other than a recommendation for proper blood sugar control. (24)
As the disease progresses, you may need different therapies or a combination of treatments. Not everyone requires the same number of shots, and not everyone has an improvement in vision after treatment. (25) In some cases, treatment simply helps keep the disease from getting worse as quickly as it otherwise would.
Conventional diabetic retinopathy treatment may include: (26)
- Blood sugar control: strategies to keep blood sugar in a healthy range, including diet, exercise and diabetes medicines
- Anti-VEGF injections: shots given directly into the eye to reduce swelling, which may improve vision and slow additional vision loss
- Steroid injections: shots given directly into the eye, which may have the same impact as anti-VEGF shots
- Laser surgery: laser beams aimed directly at the leaky blood vessels to seal them off and keep them from growing
- Vitrectomy: removal of gel, blood and/or scar tissue from the eye to help light enter the eye better, usually only in advanced diabetic retinopathy cases
12 Natural Tips for Prevention & Management of Diabetic Retinopathy
Is diabetic retinopathy curable? Sometimes. In mild cases, proper blood sugar control can reverse the blood vessel damage and erase symptoms of the disease. In most cases, treatment can also keep the disease from getting worse, even if the existing damage cannot be erased. Thankfully, you can prevent or slow diabetic retinopathy.
If you have a diabetes, consider these tips for preventing diabetic retinopathy altogether or for keeping it from getting worse: (27, 28)
- Keep your blood sugar in your target range
- Follow your diabetes diet and exercise plan (at least 150 minutes of aerobic activity per week for people who are well enough to exercise)
- Work to keep your blood pressure and cholesterol under control by getting them checked regularly and following the advice of your health care provider
- Quit smoking
- Get an eye exam as soon as you notice any changes in your vision
- Go to the eye doctor at least once every year and tell them you have diabetes (you may need to go every 2–4 months if you have early disease or are high-risk)
- Get treatment for diagnosed diabetic retinopathy sooner rather than later
- Ask if glasses or contacts can help correct your symptoms
- Get training from a low vision and rehabilitation clinic to learn coping and lifestyle tips that can help you adjust to any temporary or permanent vision loss
- Find out if Mirtogenol™ — a combination of Pycnogenol®, which is an extract of French maritime pine bark, and Mirtoselect® from bilberry — may be right for you, as these standardized natural products may help reduce bleeding in the eye (29, 30)
- Ask whether you should take a folic acid or vitamin B12 supplement to help address vitamin deficiencies that can result from certain diabetes treatments (31)
- Talk with a health care provider about these other natural therapies with early research supporting their possible effectiveness in diabetic retinopathy prevention or treatment: (32)
- Danshen dripping pills (Salviae miltiorrhiae, Radix notoginseng and borneol) and some other Traditional Chinese Medicines
- Fenugreek seed
- Gingko biloba extract
You should follow the therapies recommended by a health care professional to treat your diabetes and other health conditions. During your doctor visits or trips to the pharmacy, tell them about all medicines, supplements and herbs you use so that they can let you know if there could be any interaction. For example, some supplements can raise blood pressure, which can be harmful if you have diabetic retinopathy or other eye diseases (like glaucoma). Do not try something new without first talking to your health care provider.
With diabetic retinopathy, prevention and early detection are key. See an eye doctor immediately if you notice changes in your vision. If you have diabetes but no symptoms of vision problems, get regular eye exams and work hard to keep your blood sugar, blood pressure and cholesterol in the target range for someone your age, height, gender and weight.
Since diabetes is a chronic health condition, your efforts to prevent or manage diabetic retinopathy also have to be chronic. That means that you can’t stop working to control your blood sugar and keep your eyes healthy. Ever! It is a lifelong responsibility if you have diabetes.
Thankfully, blindness from diabetic retinopathy is largely preventable, and treatment is fairly effective and advanced. If you start early, stay active, and regularly work toward eye (and blood sugar) health, you may be able to entirely avoid complications from diabetic retinopathy. And preserving your vision is worth the effort.