5 Ways to Slow the Progression of Diabetic Retinopathy

Diabetic retinopathy is a complication of raised blood sugar levels. If left untreated, it can lead to permanent vision loss.

Woman lowering her glasses with her right hand to look at her laptop

Malaysians, beware! People with diabetes and of Asian ethnicity have a higher risk of developing diabetic retinopathy than people from other parts of the world. The disease is especially prevalent among those who: 

  • Are pregnant 
  • Have been living with diabetes for years 
  • Have high cholesterol and blood pressure  
  • Struggle to maintain control over blood sugar levels 

Read on to learn more about the disease’s progress, and treatment options that can help improve a person’s eyesight.

The Stages of Diabetic Retinopathy 

According to Eu Yan Sang Physician Vong U Chan, Traditional Chinese Medicine (TCM) believes that diabetes develops from Qi, Yin and Yang Deficiencies. The symptoms of diabetic retinopathy stems from Blood and Phlegm Stagnation.

There are two stages: proliferative and non-proliferative diabetic retinopathy.

Non-proliferative diabetic retinopathy 

People with non-proliferative diabetic retinopathy (NPDR) will have blurry vision. Tiny blood vessels in the eyes can leak, making the retina swell. The macula is a retina component that transforms the light that enters the eyes into images. Swelling of the macula is one of the most common causes of vision loss.

Man reaching out to touch a laptop with his left hand despite having blur vision
Exudates and a narrowing of blood vessels in the retina can decrease vision quality.

In addition, NPDR can close off blood vessels in the retina, preventing blood from reaching the macula. Tiny particles that ooze liquid may also form in the retina. Both of these changes may directly impair a person’s eyesight.

It has to be noted that NPDR can be further broken down into mild, moderate and severe NPDR. The sole symptom of mild NPDR is microaneurysms. These are tiny red spots within the eye that are surrounded by yellow-coloured rings.

Moderate NPDR is characterised by the occurrence of one or more haemorrhages or microaneurysms, as well as: 

  • Hard exudates – fat or protein-containing materials that settle in the layers of the outer retina 
  • Venous beading – abnormal constriction or dilatation of venules (small blood vessels) in the retina 
  • Cotton wool spots – spots that appear like fluffy and white patches on the retina 

Severe NPDR can be recognised by:  

  • Two or more instances of venous beading 
  • More than 20 haemorrhages within the retina 
  • Irregular branching or dilation of existing blood vessels within the retina 

Proliferative diabetic retinopathy 

The more advanced stage of this eye disease is called proliferative diabetic retinopathy (PDR). It involves the growth of new blood vessels in the retina, which bleed into the vitreous, a gel-like fluid attached to it. Minor bleeding will induce the appearance of vision spots (also called floaters), while severe bleeding can cause temporary vision disruption. 

Treatments that Slow Diabetic Retinopathy Progression 

There are several steps that can help lower a person’s risk of developing the disease or prevent deterioration. These will include:  

  • Attending all screening appointments 
  • Controlling cholesterol, blood sugar, and blood pressure levels 
  • Taking medications prescribed by a healthcare provider 
  • Maintaining a healthy weight by exercising regularly and eating a nutritionally balanced diet 
  • Seeking medical attention promptly if there are vision changes  

Clinical and traditional treatments may also be considered to achieve the same goals.

Vitrectomy 

A healthcare provider may recommend a vitrectomy – a type of eye surgery – for people with PDR. It’s aimed at removing blood and vitreous before it leaks into vessels in the back of the eye. Scar tissue may also be pulled out from the retina. These actions will enable light rays to focus better on the retina, improving vision clarity.

Laser surgery 

The procedure is performed to reduce retina swelling by sealing off leaking blood vessels. It can also be used to shrink components of the circulatory system. Sometimes, a person may require more than one treatment session. 

Prescription medication 

A healthcare provider may propose anti-VEGF (vascular endothelial growth factor) injections to the eye to calm macula swelling and stall vision loss. VEGF is a protein that supports the production of blood vessels.

Steroid injections are an alternative treatment for a swollen macula. However, the number of injections required is determined over time.

Acupuncture 

The main goals of acupuncture treatment for diabetic retinopathy are to: 

  • Improve eyesight during the early stages of NPDR 
  • Reduce bleeding throughout the PDR stage 

A few of the points that can activated are cuan zhu (BI2, 攒竹), tai yang (EM5, 太阳), yang bai (GB14, 阳白), and guang ming (GB37, 光明).

Herbal formulas 

Licensed TCM practitioners may suggest the use of formulas like Ming Mu Di Huang (明目地黄丸) and Shi Hu Ye Guang (石斛夜光丸) pills. These can help nourish the Kidney and Liver organ systems, thus improving eye health. A powdered formula that uses marigold flower (wan shou ju, 万寿菊) extract and fortified with lutein and zeaxanthin can also be used to enhance macula and retina health.

Consequently, it can alleviate dry eyes and blurred vision. 

Given that diabetic retinopathy is incurable, treatment focuses solely on ensuring eyesight preservation. Traditional medicine addresses health disorders through syndrome differentiation. Hence, a person must seek consultation with a licensed practitioner to determine the severity and stages of their illness before a treatment regimen can be proposed.

References

  1. National Health Service. Diabetic retinopathy. [online] [Accessed 21 July 2022]
  2. American Academy of Ophthalmology. 2021. Diabetic Retinopathy: Causes, Symptoms, Treatment. [online] [Accessed 21 July 2022]
  3. MODERNOPTOMETRY. 2019. The Four Stages of Diabetic Retinopathy. [online] [Accessed 21 July 2022]

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