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After the kidneys, the eyes are usually the second major organ that is damaged by the effects of diabetes. The signs of damage to the eyes include blurry vision, spots, and loss of vision, which can lead to blindness if the macula is damaged and there is a loss of blood supply to the retina.
The retina is a nerve layer at the back of the eye that senses light and helps send images to the brain, similar to film in a camera. Diabetic retinopathy is caused by damage to blood vessels of the retina, leading to the loss of vision and even blindness. In the initial stages (called non-proliferative diabetic retinopathy), the arteries in the retina become weakened and leak fluid or blood, forming small, dot-like hemorrhages. This can blur or distort the images that the retina sends to the brain leading to blurred vision, called “background retinopathy”.
In the next stage (proliferative retinopathy), circulation problems cause areas of the retina to become oxygen-deprived or ischemic. New, fragile blood vessels develop in the retina and branch out into the vitreous humor in the middle of the eye as the circulatory system attempts to maintain adequate oxygen levels within the retina. This is called neovascularization. Unfortunately, these blood vessels are fragile and hemorrhage easily, causing blood to leak into the retina and vitreous. This creates spots or floaters, causing a decrease in vision and scarring. In the later stages of the disease, continued abnormal blood vessel growth and scar tissue cause serious problems such as retinal detachment and glaucoma.
The likelihood and severity of retinopathy increase with the duration of diabetes and is likely to be worse if blood glucose is poorly controlled. Almost all people who have had diabetes for more than 30 years will show signs of diabetic retinopathy, as it is the leading cause of blindness in working-age Americans.
Diagnosis & Tests
The diagnosis of diabetic retinopathy is made following a detailed examination of the retina with an ophthalmoscope. Ophthalmoscopy is an examination of the back part of the eyeball (fundus), which includes the retina, optic disc, choroid, and blood vessels. Ophthalmoscopy is performed as part of a routine physical or complete eye examination to detect and evaluate symptoms of retinal detachment and eye diseases such as glaucoma and cataracts. Most patients with diabetic retinopathy are referred to vitreo-retinal surgeons who specialize in treating this disease.
Cataracts & Glaucoma
Diabetics are twice as likely to develop eye diseases such as cataract and glaucoma. A cataract is a clouding or opaque area that develops over the lens of the eye, and thickens, preventing light rays from passing through the lens and focusing on the retina.
You may have a cataract if you need a stronger light for reading or sewing, but, no matter how bright the light, your vision seems dim; or, the glare of a car’s headlights makes it difficult to see. The primary causes of cataracts include glycosylation and oxidation -- due to the accumulated exposure to ultraviolet sunlight, tobacco, or diabetes with uncontrolled glucose levels that damage the proteins in the eye lens. Consequently, one of the key strategies to either slow down or even prevent the formation of a cataract is to reduce the amount of glycosylation and oxidation – by wearing sunglasses and eating foods and supplements that contain antioxidants, e.g. spinach, red grapes, carrots, bilberry, beta carotene, Vitamin C, l-carnosine.
Studies continue to show that people with cataracts tend to have low serum levels of beta carotene and Vitamin C. These nutrients will not cure cataracts, but they will prevent further damage. Even after someone has had cataract surgery, he/she will still need to consider antioxidant nutrients, otherwise, the new lens will become cloudy from the same oxidative process.
Glaucoma is an increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. Glaucoma is called the “sneak thief” of sight because it has no obvious signs at first – it is painless and has no effect on vision. By the time you notice that your vision has deteriorated, glaucoma has done its damage. Consequently, annual exams are a must, especially if glaucoma runs in your family.
A normal eye is filled with fluid, which drains through tissue between the iris and the cornea. With glaucoma, the draining of the fluid slows down or stops completely as the eyes’ “drainage pipes” become backed up like a clogged drain. The backup of the fluid builds intraocular pressure throughout the eye, damaging blood vessels that feed the retina and optic nerve. Without the proper nutrients, the optic nerve begins to die, and so does your vision.
It is important to note that many people with glaucoma don’t realize there is a loss of vision because they don’t actually “see” dark areas – there are no visible “walls” of the so-called “tunnel”. People with peripheral vision loss just have a narrower visual field. People with normal vision see images of their surroundings and have a naturally limited range of vision. They do not “see” darkness all around them. People with glaucoma don’t “see” darkness either – they just see less of their surroundings. This is why annual eye exams are so important – they can catch the glaucoma before irreparable damage is done.
Once your doctor diagnoses glaucoma, eye drop medication will be necessary to reduce the eye pressure and prevent any further loss of vision. High doses of supplements such as natural Vitamin C with bioflavonoids (1000 to 2000 mg) and bilberry/eyebright (350 to 500 mg) may help to draw fluid out of the eye, but this has not been completely verified with any well-controlled clinical studies.
In general, for good eye health, avoid the processed foods, drink raw vegetable juices, and eat more green vegetables and bright-colored vegetables such as spinach, kale, broccoli, and red/yellow/orange peppers for the carotenoids, lutein, lycopene, and zeaxanthin. Also, eat wild salmon and egg yolks for the Omega-3s. Refer to the wellness protocol section in Chapter 15 of the Death to Diabetes book and the Power of Juicing ebook for more details about eye health.
Treatment for diabetic retinopathy depends on the stage of the disease and is directed at trying to slow or stop the progression of the disease.
In the early stages of Non-proliferative Diabetic Retinopathy, treatment other than regular monitoring may not be required. Following your doctor's advice for diet and exercise and keeping blood sugar levels well-controlled can help control the progression of the disease. Use a superior nutrition-based program (such as the Death to Diabetes wellness program) to eat more green vegetables, drink more raw vegetable juices, and eat foods with Omega-3s such as wild salmon, organic eggs, walnuts, and flaxseed. This will help to properly control blood sugar levels without medication.
If the disease advances, leakage of fluid from blood vessels can lead to macular edema. Laser treatment (photocoagulation) is used to stop the leakage of blood and fluid into the retina. A laser beam of light can be used to create small burns in areas of the retina with abnormal blood vessels to try to seal the leaks.
When blood vessel growth is more widespread throughout the retina, as in proliferative diabetic retinopathy, a pattern of scattered laser burns is created across the retina. This causes abnormal blood vessels to shrink and disappear. With this procedure, some side vision may be lost in order to safeguard central vision.
Some bleeding into the vitreous gel may clear up on its own. However, if significant amounts of blood leak into the vitreous fluid in the eye, it will cloud vision and can prevent laser photocoagulation from being used. A surgical procedure called a vitrectomy may be used to remove the blood-filled vitreous and replace it with a clearfluid to maintain the normal shape and health of the eye.
Persons with diabetic retinopathy can suffer significant vision loss. Special low vision devices such as telescopic and microscopic lenses, hand and stand magnifiers, and video magnification systems can be prescribed to make the most of remaining vision.
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