You’ve got diabetic retinopathy. Is it reversible? Can you undo the damage that’s already been done?
“It depends,” says Ben Szirth, PhD. Szirth is the director of applied vision research and ophthalmic telemedicine at Rutgers New Jersey Medical School. “Dr. Ben” has volunteered countless hours of his life to people with diabetes, conducting free eye screenings and consultations in many different countries.
It is possible, Szirth believes, for some patients to reverse and repair the eye damage commonly experienced by people with diabetes. Getting your blood sugar and blood pressure back into a healthy range can allow the body to heal hemorrhages characteristic of diabetic retinopathy. But not all patients will be so lucky — more severe levels of damage may be permanent.
That’s why regular screening and early intervention can be so important. If eye damage is detected early, it can be fixed before it gets worse.
“The best thing is prevention,” says Szirth.
What is Reversal?
There’s not much of a consensus on reversing the condition. As of this writing, Google’s number one search result for the question states that diabetic retinopathy is not reversible. The second result states the very opposite.
Diabetic retinopathy is caused by damage to the blood vessels in the retina, the part of the eye that senses light. After prolonged exposure to high blood sugar and blood pressure, these little blood vessels begin to swell, burst, and leak blood into the eye. Eventually, these abnormal blood vessels can cause vision impairment and potentially even blindness.
When patients experience vision impairment or loss, medication and surgery can help repair their eyesight. The American Diabetes Association and the National Institutes of Health, for example, agree that vision impairment can be “reversed” with treatment.
But the root cause of diabetic retinopathy can only be addressed with good metabolic health. Szirth stresses that the body can actually heal itself — reversing damage to the retina — if you take the right actions and do it early enough.
The Progression of Diabetic Retinopathy
Diabetic retinopathy is divided into four stages of severity. The first stage, mild non-proliferative retinopathy, is marked by small areas of swelling and microaneurysms. In the fourth stage, proliferative diabetic retinopathy, new fragile and abnormal blood vessels grow along the interior of the retina, which causes both copious leakage and the development of scar tissue.
Dr. Szirth approached the topic using a different framework. He described three different types of retinal hemorrhaging: dot hemorrhages, flame hemorrhages, and intraretinal microvascular abnormalities (IrMAs).
“Dot hemorrhages are typically small, and they can usually resolve within 90 days if you bring your glucose level closer to normal. It’s going to self-resolve if you take care of yourself.”
“Flame hemorrhages are blood vessels that break. Those take a lot longer to resolve than dot hemorrhages. It depends on the size. If it’s small, it could take six months to clear. But in some cases, we have to do surgery immediately.”
IrMAs, the final type of hemorrhage, are usually found in patients with very high glucose levels, an “A1C of maybe 12 or 13 percent, or off the scale,” and are a defining characteristic of the third stage of diabetic retinopathy. But even these serious hemorrhages can be naturally healed, at least in some circumstances. “If you will actually follow the regimen carefully, we can bring you back.”
Another important factor is the location of the damage. The macula is a small part of the retina that provides our sharpest vision. The fovea, smaller still, is the most important part of the macula. Swelling and leaking in these critical areas will result in much swifter and more serious vision impairment.
Szirth shared me with one anecdote of a 21-year-old with type 1 diabetes that he treated recently. This young man, who was coping with severe diabetes burnout, had developed hundreds of dot hemorrhages and several flame hemorrhages. With help from his family, he recommitted himself to a better diet and good blood sugar control. A year later, 99 percent of the damage had been repaired.
Not everyone is so lucky. Szirth has treated patients with far less hemorrhaging, but more of it near the fovea. In these cases, metabolic control may not be enough to prevent further vision impairment, and medical intervention will be necessary.
“When some parts of the eye die, we can’t turn that around.”
The Importance of Screening and Prevention
If you want to prevent, slow, stop, or reverse diabetic retinopathy, the time to act is now. Annual eye examinations are the best way to detect issues before they cause irreversible damage. If you’ve clicked on this article because you have even the slightest worry about your vision, it’s a good idea to schedule an appointment as soon as possible.
“The key is yearly screening.”
Szirth recommends going one step beyond the typical comprehensive eye exam. He encourages you to seek out an ophthalmologist with access to optical coherence tomography angiography (OCT-A) screening.
OCT-A, an advanced imaging technology, uses lasers to scan the blood vessels below the retina, specifically in the fovea. “The foveal net is the best indicator of if you are going to develop retinopathy. When I follow a patient with diabetes, if their foveal net is good, we can reverse most of the retinal hemorrhages.”
Your local independent ophthalmologist probably doesn’t have the equipment to run an OCT-A screening. Szirth recommends checking with university hospitals, which “have the latest toys and technologies.”
In the meantime, the best way to prevent diabetic retinopathy, and treat it in its earliest stages, is good metabolic health:
“You have two things to do. You have to get your blood sugar under control, and you have to get your blood pressure under control.”
Szirth also believes that glycemic variability — blood sugar spikes and rollercoasters — have an outsized effect on retinopathy progression. “That’s my experience. It’s limited, but I’ve found the same thing when I’ve screened patients in Florida, New Jersey, and Canada.” He’s a big believer in both continuous glucose monitors (CGMs) and closed-loop systems, for their ability to help maximize time-in-range.
The bottom line? With both diligence and good luck, it is sometimes possible to reverse diabetic retinopathy.