Diabetic Retinopathy

Almost half of the estimated 16 million people in the United States who have diabetes will develop some degree of diabetic retinopathy, by far the most common form of diabetic eye disease. The retina weakens and bleeds, endangering vision. Good blood sugar control and blood pressure management, as well as yearly examinations and treatment, are the best methods of preventing eye complications due to diabetes. This is discussed in detail in the diabetes section. However, even with good control, I have seen patients yield to retinopathy after having diabetes for more than twenty or thirty years. I believe this is preventable and treatable with proper herbal supplementation.

Ophthalmologists have a special advantage in identifying and treating retinopathy because they can directly see the blood vessels and the tiny capillaries in the eye. Therefore every diabetic needs an annual dilated eye exam. Eye doctors know that these oxygen-sensitive blood vessels can become abnormal and exhibit ballooning (microaneurism), fat leakage (exudate) and blood leakage (hemorrhage). Scattered capillary leakage throughout the eye causes a condition known as background diabetic retinopathy, while leakage in the central retina causes macular edema. Oxygen starvation can also cause a third and more severe form of the disease called proliferative diabetic retinopathy, in which new blood vessels grow uncontrollably on the surface of the retina and may even bleed into the eye (vitreous hemorrhage). Macular edema is a similar condition that affects diabetics, and can be treated in a similar fashion with herbs, but with modifications related to fluid transport

To quickly stop retinal bleeding, I recommend tien chi root, two grams twice per day. Continue long-term use to prevent further bleeding – six months at one gram twice per day is usually very effective, expecially if used along the Yunnan Paiyao, a standard anti-bleeding TCM medicine. Tien chi root is the best choice. Although ginkgo leaf has been shown to increase blood flow to the eye without changing pulse or blood pressure (Chung et al., 1999), there are some indications that it may contribute to micro-hemmorhages in weakened vessels. To improve general blood vessel health once you have had retinopathy, I recommend continued regular use of herbs from the vessel protective group forever. Bilberry and blueberries are especially important, and I recommend using 1/2 cup per day, or approximately one frozen bag of blueberries (available year round) per week. Use organic blueberries if you can get them. Gotu Kola is also useful. Recently Dr Abel and I developed a formula called iHeal which contains high doses of tien qi root and gotu kola, along with synergistic herbs.  Note that these methods will only work if blood sugars are kept under good control.

Research Highlights

• A clinical study on 48 eyes was done to measure the ability of the Ayurvedic preparation called saptamrita lauha in absorption of retinal hemorrhages. Rapid absorption of hemorrhage was observed in both diabetic and hypersensitive subjects. Mean duration for absorption was about 17 days, with complete clearance in three eyes, and partial clearance in the rest. Follow-ups studies showed a 25% recurrence in treated eyes, compared to greater than 50% recurrence in control eyes (Sharma et al., 1992).

• Making this medicine requires a starting drug called lauha (iron) bhasma, considered to be a powerful astringent tonic. One method of making lauha bhasma is to soak iron for seven days in pomegranate juice, then roasting it seven successive times to create a purified iron oxide powder. You can then make Saptamrita lauha by mixing two parts of lauha bhasma with one part each of licorice root, haritaki fruit, vibhitaki fruit, amla fruit, ghee and honey. The standard dose is 250 mg twice a day (Namjoshi, 1978, Nadkarni, 1954).

• Bensky and Gamble report that two cases of retinal hemorrhage were treated with decoction of forsythia fruit (lian qiao or Forsythia suspensa). At four weeks there was good resorption of leakage and some visual acuity improvement (reported in Bensky and Gamble, 1993).