Managing Diabetic Macular Edema Safely

For people living with vision loss caused by diabetic macular edema (DME), it’s a clear catch-22: Although exercise may help prevent or stop DME from progressing by stabilizing blood sugar levels,

exercising when it’s hard to see can be a real challenge.

Indeed, according to some research, people who have vision impairment for any reason spend about half as much time engaged in moderate to vigorous physical activity as those with normal eyesight. One of the most common reasons for this is a fear of falling.

 That’s too bad, though, especially for people with DME due to diabetic retinopathy, because the more exercise a person gets, the less severe their vision impairment tends to be.

What’s more, certain activities may make DME worse when performed during certain times. While working out with DME-related vision problems may seem complicated, once you know which exercises benefit and protect your eyes the best, your fitness routine can go off without a hitch.

How Blood Sugar Levels Impact Your Vision

Over time, high blood sugar levels can damage the blood vessels in the eye, causing them to leak. As a result, the macula of the eye — the area of the retina that is responsible for detailed vision — can swell, which in turn can lead to blurry vision and other changes. Anything that can help bring down blood sugar levels, including medication, diet changes, and physical activity, can help stop vision loss or even restore vision.

“People who can maintain near-normal blood sugar levels many times can avoid vision loss or damage to their eyes from diabetes,” says Sunir Garg, MD, a spokesperson for the American Academy of Ophthalmology and a professor of ophthalmology at Wills Eye Hospital in Philadelphia. “Even for people who’ve had less-than-ideal control, improving blood sugar levels can help slow down future vision loss.”

5 Low Vision–Friendly Exercises to Try

The best type of exercise for you is, generally speaking, the one you’ll do, says Steven Reed, OD, the president of the American Optometric Association. The American Diabetes Association recommends that adults with diabetes do 150 minutes of moderate to vigorous aerobic activity three days a week, and two to three sessions of resistance training a week.

That said, some types of physical activity are better for controlling blood sugar levels and safer for anyone with low vision. Here are some options to consider.

Walking

Walking is one of the most accessible activities you can do. In many parts of the country, all you need is a pair of sneakers. Moreover, the risk of an injury — to your eyes, or falling — is relatively low. Aerobic activity (exercise that increases your heart rate) can help lower your blood sugar levels.

 Men should aim for about 87 steps per minute, and women should aim for 100 steps per minute.

 If your vision prevents you from walking outside on a road, try walking indoors, on a treadmill. And if you really desire a walk outside, walk around a local track so you are on a flat, predictable path.

Cycling

Like walking, cycling is a good aerobic activity that can help manage your blood sugar levels and improve your insulin sensitivity.

 If you don’t feel comfortable biking outside or on a road, use a stationary bike, says Dr. Reed. And even if you can see well enough to ride outside, aim to bike during the daylight hours or bring along a friend.

Swimming

Swimming is another good type of aerobic exercise for people who have some vision loss, says Reed, and it has even been found to help improve blood sugar control.

 To make swimming a consistent part of your exercise routine, invest in prescription goggles to help you see underwater.

Yoga

Research shows that yoga, particularly restorative or Anusara yoga, can improve insulin sensitivity and blood glucose levels, which can help people manage type 2 diabetes. One caveat: Inverted asanas (poses) in which your heart is raised above your head — such as Sarvangasana — can cause blood to pool into the head or upper body, which might lead to bleeding in the eye. If you are in a class where inversion poses are being performed, ask your instructor for a modification.

Tai Chi

Tai chi is a gentle form of martial art that pairs slow movements with controlled breathing and meditation. There’s evidence that it can improve blood sugar levels in people with type 2 diabetes

 and improve balance in older adults with diabetes-related vision problems.

For an overall better exercise experience, it’s also a good idea to switch up your workouts — say, by doing yoga one day and walking the next. “Doing a variety of different exercises including cardiovascular activity, some light weight training, as well as exercises that encourage mobility, such as yoga, can all be beneficial, and a combination of them is likely the most helpful,” says Dr. Garg.

3 Exercises You Shouldn’t Do if You Have DME

While most exercise is good for people with DME, there are some instances in which it may cause more harm — at least, temporarily — especially if your DME has progressed.

Some people with DME have damaged blood vessels in the eyes that may be prone to bleeding, says Reed. “If people have significant bleeding in the eye due to advanced diabetic eye disease … (they may need) to avoid straining for a short period of time,” says Garg.

“Once I get their eye disease under control with treatment, I quickly allow them to resume all of their normal physical activities,” says Garg. Some activities that your doctor may want you to avoid include:

  • Heavy weight lifting, in which you may strain to power lift, damaging the blood vessels in your eyes
  • High-impact workouts, such as running and HIIT routines, which may also cause strain on the eyes
  • Contact sports, such as football or basketball, in which your eye may be injured by a ball or another player

Building an Exercise Routine if You Have Low Vision

Whether you’re new to exercise or have recently experienced some vision loss, there are ways to kick-start your workout routine.

Here are a few ways to get started.

  • Enlist a family member or friend to exercise with you. They can help guide you, if needed, give you a ride to the gym or park, or simply keep you motivated to stick to your workout.
  • Work with a physical therapist, personal trainer, or fitness instructor. Find a professional who can give you more support during a workout or teach you how to do an exercise safely.
  • Listen to workout videos online. The YouTube channel Eyes-Free Fitness & BlindAlive offers audio-based workouts, including yoga, Pilates, and barre — all of which you can do at home.

What’s most important is that you stay active, says Reed. “We need people to be healthy and get out there and lower their (blood sugar levels),” he says.

The Takeaway

If you’re living with diabetic macular edema (DME), regular exercise can help stabilize your blood sugar and support your eye health. It’s important to choose activities like walking, swimming, or tai chi, which are easier on your eyes. Pairing up with a friend or a physical trainer can also help you stay active safely. Some exercises to avoid if you have DME are high-impact workouts, weight lifting, and contact sports.