Low Vision Rehabilitation and Eye Exercises: A Comprehensive Guide to Tertiary Prevention of Diabetic Retinopathy

Abstract

Diabetic retinopathy (DR) is a leading cause of vision loss in patients with diabetes. While medical treatments like retinal laser photocoagulation, anti-VEGF therapy, and vitrectomy are primary, complementary therapies are gaining increasing attention. Based on the existing literature, a healthy lifestyle, including a balanced diet, stress management techniques, and regular physical activity targeting DR, can help regulate blood sugar levels and improve overall physical and mental health to reduce complications. This article explores physical activities and visual training methods related to DR, emphasizing complementary therapies, even though some of these practices are currently not fully integrated into evidence-based ophthalmology. Low vision exercises and aids help patients make the most of their remaining vision, improving their ability to perform everyday tasks, reducing the impact of vision loss, and promoting independence. There is some evidence that eye-related physiotherapy can improve the quality of life for patients with DR, although selection bias cannot be excluded in the presented studies. Consistent physical activity promotes holistic health, and therapies should be regularly monitored by ophthalmologists. This review further helps integrative healthcare professionals in offering appropriate therapies for rehabilitation purposes in the treatment of ophthalmic diseases, particularly DR.

Keywords: Bates–Schneider method; animal-assisted therapy; diabetic retinopathy; low vision rehabilitation; ocular yoga; orthoptic exercises; physical exercise; visual training.

Figure 1

A flowchart of clinical steps in integrative medical care helping ophthalmologists, visual therapists, and behavioral optometrists in eye-related lifestyle interventions. The chart emphasizes the importance of correct diagnosis and strict medical treatments based on the recommendations of a specialist ophthalmologist (self-edited).

Figure 2

The role of lifestyle medicine in the system of ophthalmology treatments. If a specialist has identified multifactorial causes of the patient’s eye disease impairing quality of life, a therapeutic decision can be made in addition to the professional treatment of the pathophysiological cause, as well as personalized complementary therapy involving lifestyle change (self-edited). The red arrow in the flowchart represents a transition point where the negative outcomes—exacerbation or progression of ocular disease, visual disturbance, and decreased quality of life—lead to the implementation of lifestyle medicine and ophthalmology interventions.