Retinopathy

The term retinopathy indicates damage to the retina at the back of the eye. Several conditions, such as diabetes and high blood pressure, can lead to the formation of retinopathies.

Checklist for Retinopathy

Rating Nutritional Supplements Herbs
2Stars Proanthocyanidins
Vitamin E (for prevention of retrolental fibroplasia in premature infants, and for prevention of diabetic retinopathy)		 Bilberry
1Star Flavonoids (quercetin, rutin)
Following are associated with diabetic retinopathy: Selenium, vitamin A, vitamin C, and vitamin E (combined)
Magnesium
Vitamin B12
Vitamin E (associated with abetalipoproteinemia)		 Ginkgo biloba
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of retinopathy? Retinopathy often has no early warning signs. If retinopathy progresses, partial or total blindness may result.

How is it treated? In treating advanced retinopathy, doctors may use laser surgery to shrink abnormal blood vessels at the back of the eye. This treatment results in a loss of some peripheral (side) vision, a sacrifice that preserves the remaining field of vision. Laser surgery for retinopathy may also reduce color and night vision. A surgical alternative to laser surgery, called vitrectomy, is sometimes used if the eye has become cloudy due to hemorrhage (bleeding). Vitrectomy replaces the vitreous humor (transparent fluid in the interior of the eyeball behind the lens) with a salt solution.

Dietary changes that may be helpful: Animal studies suggest that dietary fructose may contribute to the development of retinopathy.1 Although such an association has not been demonstrated in humans, some doctors advise their diabetic patients to avoid foods containing added fructose or high-fructose corn syrup. Fructose that occurs naturally in fruit has not been found to be harmful.2

Lifestyle changes that may be helpful: In a study of people with diabetes, cigarette smoking was found to be a risk factor for the development of retinopathy.3 In a study of people with type 1 (insulin-dependent) diabetes, those who maintained their blood sugar levels close to the normal range had less severe retinopathy, compared with those whose blood sugar levels were higher.4 Tighter control of blood-sugar levels can be achieved with a medically supervised program of diet, exercise, and, when appropriate, medication.

Nutritional supplements that may be helpful: Free radicals have been implicated in the development and progression of several forms of retinopathy.5 Retrolental fibroplasia, a retinopathy that occurs in some premature infants who have been exposed to high levels of oxygen, is an example of free radical-induced damage to the retina. In an analysis of the best published trials, large amounts of vitamin E were found to reduce the incidence of severe retinopathy in premature infants by over 50%.6 7 Some of the evidence supporting the use of vitamin E in the prevention of retrolental fibroplasia comes from trials that have used 100 IU of vitamin E per 2.2 pounds of body weight in the form of oral supplementation.8 Use of large amounts of vitamin E in the prevention of retrolental fibroplasia requires the supervision of a pediatrician.

Vitamin E has also been found to prevent retinopathy in people with a rare genetic disease known as abetalipoproteinemia.9 People with this disorder lack a protein that transports fat-soluble nutrients, and can therefore develop deficiencies of vitamin E and other nutrients.

In one trial, vitamin E failed to improve vision in people with diabetic retinopathy,10 although in a double-blind trial, people with type 1 diabetes given very high amounts of vitamin E were reported to show a normalization of blood flow to the retina.11 This finding has made researchers hopeful that vitamin E might help prevent diabetic retinopathy. However, no long-term trials have yet been conducted with vitamin E in the actual prevention of diabetic retinopathy.

Because oxidation damage is believed to play a role in the development of retinopathy, antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic retinopathy. During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy.12 People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.

Low blood levels of magnesium have been found to be a risk factor for retinopathy in white people with diabetes,13 14 but not in black people with diabetes.15 So far, no studies have determined whether supplementing with magnesium would help prevent the development of retinopathy.

One study investigated the effect of adding 100 mcg per day of vitamin B12 to the insulin injections of 15 children with diabetic retinopathy.16 After one year, signs of retinopathy disappeared in 7 of 15 cases; after two years, 8 of 15 were free of retinopathy. Adults with diabetic retinopathy did not benefit from vitamin B12 injections. Consultation with a physician is necessary before adding injectable vitamin B12 to insulin.

Quercetin (a flavonoid) has been shown to inhibit the enzyme, aldose reductase.17 This enzyme appears to contribute to worsening of diabetic retinopathy. However, because the absorption of quercetin is limited, it is questionable whether supplementing with quercetin can produce the tissue levels that are needed to inhibit aldose reductase. Although human studies have not been done using quercetin to treat retinopathy, some doctors prescribe 400 mg of quercetin three times per day. Another flavonoid, rutin, has been used with success to treat retinopathy in preliminary research.18

Proanthocyanidins (OPCs), a group of flavonoids found in pine bark, grape seed, and other plant sources have been reported in preliminary French trials to help limit the progression of retinopathy.19 20 In one controlled trial, 60% of people with diabetes taking 150 mg per day of OPCs from grape seed extract had no progression of retinopathy compared to 47% of those taking a placebo.21

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Bilberry extracts standardized to contain 25% anthocyanosides have been suggested as a treatment for people with early-stage diabetic or hypertensive retinopathy. In a small preliminary trial, people with various types of retinopathy, including diabetic retinopathy and macular degeneration, were given 600 mg of bilberry extract per day for one month.22 While researchers found that the tendency to hemorrhage in the eye was reduced and that blood vessels were strengthened, there were no reports of improved vision. A small double-blind trial found that 160 mg of bilberry extract taken twice per day for one month led to similar improvements in blood-vessel health in the eye and slightly improved vision in people with diabetic and/or hypertensive retinopathy.23 Larger and longer clinical trials are needed to establish the effectiveness of bilberry for treating retinopathies.

The use of 160 mg per day of a standardized extract of Ginkgo biloba for six months has been reported in a small double-blind trial24 to improve impaired visual function in people with mild diabetic retinopathy.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

1. Anonymous. Retinopathic effect of sucrose-rich diets due to fructose. Nutr Rev 1982;40:117–8,128.

2. Gaby AR. Fructose, glycosylation, and aging. Townsend Letter for Doctors and Patients 1999;Apr:107–8.

3. Paetkau ME, Boyd TAS, Winship B, Grace M. Cigarette smoking and diabetic retinopathy. Diabetes 1977;26:46–9.

4. McCance DR, Hadden DR, Atkinson AB, et al. Long-term glycaemic control and diabetic retinopathy. Lancet 1989;2:824–8.

5. Alieva ZA, Gadzhiev RV, Sultanov M. Possible role of the antioxidant system of the vitreous body in delaying the development of diabetic retinopathy. Oftalmol Zh 1985;(3):142–5 [in Russian].

6. Johnson L, Quinn GE, Abbasi S, et al. Effect of sustained pharmacological vitamin E levels on incidence and severity of retinopathy of prematurity: A controlled clinical trial. J Pediatr 1989;114:827–38.

7. Raju TN, Langenberg P, Bhutani V, Quinn GE. Vitamin E prophylaxis to reduce retinopathy of prematurity: a reappraisal of published trials. J Pediatr 1997;131:844–50.

8. Hittner HM, Godio LB, Rudoph AJ, et al. Retrolental fibroplasia: efficacy of vitamin E in a double-blind clinical study of preterm infants. N Engl J Med 1981;305:1365–71.

9. Runge P, Muller DP, McAllister J, et al. Oral vitamin E supplements can prevent the retinopathy of abetalipoproteinaemia. Br J Ophthalmol 1986;70:166–73.

10. De Hoff JB, Ozazewski J. Alpha tocopherol to treat diabetic retinopathy. Am J Ophthalmol 1954;37:581–2.

11. Bursell S-E, Schlossman DK, Clermont AC, et al. High-dose vitamin E supplementation normalizes retinal blood flow and creatinine clearance in patients with type 1 diabetes. Diabetes Care 1999;22:1245–51.

12. Crary EJ, McCarty MF. Potential clinical applications for high-dose nutritional antioxidants. Med Hypotheses 1984;13:77–98.

13. Jialal I, Joubert SM. The biochemical profile in Indian patients with non-insulin-dependent diabetes in the young with retinopathy. Diabetes Metabol 1985;11:262–5.

14. McNair P, Christiansen C, Madsbad S, et al. Hypomagnesemia, a risk factor in diabetic retinopathy. Diabetes 1978;27:1075–8.

15. Erasmus RT, Olukoga AO, Alanamu RA, et al. Plasma magnesium and retinopathy in black African diabetics. Trop Geogr Med 1989;41:234–7.

16. Kornerup T, Strom L. Vitamin B12 and retinopathy in juvenile diabetics. Acta Paediatr 1958:47:646–51.

17. Varma SD. Inhibition of aldose reductase by flavonoids: Possible attenuation of diabetic complications. Progr Clin Biol Res 1986;213:343–58.

18. Glacet-Bernard A, Coscas G, Chabanel A, et al. A randomized, double-masked study on the treatment of retinal vein occlusion with troxerutin. Am J Ophthalmol 1994;118:421–9.

19. Fromantin M. Procyanidolic oligomers in the treatment of fragile capillaries and diabetic retinopathy. Med Int 1981;16:432–4 [in French].

20. Verin MM, Vildy A, Maurin JF. Retinopathies and OPC. Bordeaux Medicale 1978;11:1467–74 [in French].

21. Arne JL. Contribution to the study of procyanidolic oligomeres: Endotelon in diabetic retinopathy (in regard to 30 observations). Gaz Med de France 1982;89:3610–4 [in French].

22. Scharrer A, Ober M. Anthocyanosides in the treatment of retinopathies. Klin Monatsblatt Augenheilk 1981;178:386–9.

23. Perossini M, Guidi G, Chiellini S, Siravo D. Diabetic and hypertensive retinopathy therapy with Vaccinium myrtillus anthocyanosides (Tegens®): Double-blind, placebo-controlled clinical trial. Ann Ottalmol Clin Ocul 1987;113:1173–7 [in Italian].

24. Lanthony P, Cosson JP. The course of color vision in early diabetic retinopathy treated with Ginkgo biloba extract. A preliminary double-blind versus placebo study. J Fr Ophtalmol 1988;11:671–4 [in French].