Macular Degeneration: Important Vitamins and Nutrition

February is Macular Degeneration Awareness Month

Macular degeneration is an issue that has personally affected our family.  My paternal grandmother has macular degeneration and she has lost much of her sight due to this disease.  My father also has some early signs, drusen, which are yellow deposits under the retina that a doctor can find using a dilated eye examination.  The kind of macular degeneration that occurs with aging is abbreviated AMD, which is short for Age-Related Macular Degeneration.  AMD destroys the central vision necessary for activities like reading or driving.  A recent study from Prevent Blindness America and the National Eye Institute has shown that women are at twice the risk of losing their sight, compared to men.  My grandmother’s AMD is severe enough that she cannot see clearly to look at pictures of my children.  She can grasp vague and general details when she sees the children in person, such as their fair hair and complexion.  She can no longer read, or pay her own bills.  She needs assistance to shop for her groceries.  So AMD affects many of the basic tasks that an older adult needs to perform in order to maintain independence.  So with a strong family history, I felt it was prudent to research strategies to prevent macular degeneration.  Here are my findings.

Many researchers have found a link between poor nutrition and macular degeneration.  The Beaver Dam Eye Study showed an increased risk for macular degeneration in  patients with the lowest levels of the antioxidant lycopene, found in certain fruits and vegetables.   In the Eye Disease Case Control Study higher serum carotenoid (beta carotene) levels showed a protective effect against macular degeneration.  In patients with high antioxidant blood levels, the Macular Degeneration Risk Factor Study found less of the most serious type of macular degeneration.

A study published by Dr. David Newsome in the Archives of Ophthalmology in February 1988, showed vision was less likely to deteriorate in macular degeneration patients who were treated with zinc supplementation. Zinc was studied because retinal zinc concentrations are usually high, and zinc is an important cofactor in retinal enzymes (such as retinol dehydrogenase and catalase).  Another study in the Journal of the American Medical Association (9 Nov 1994) showed that consumption of foods rich in the specific carotenoids lutein and zeaxanthin resulted in the most reduced risk for macular degeneration. Dark green, leafy vegetables, such as collard greens and spinach, are especially rich in these carotenoids and were specifically linked to substantially reduced risk. This study controlled for smoking and other risk factors. Smoking appears to increase macular degeneration risk.

According to the AREDS Study (Age-Related Eye Disease Study) vitamin supplements can have a protective effect against the advancement of existing macular degeneration.  Patients were given one of four treatments of zinc, antioxidants alone, a combination, and a placebo.   The specific daily amounts of antioxidants and zinc used were 500mg of vitamin C; 400IU of vitamin E; 15 milligrams of beta carotene, which is equivalent to 25,000 IU of vitamin A as beta carotene; 80 milligrams of zinc; and two milligrams of copper (see multivitamin below). In the AREDS study, this combination reduced the chance of developing advanced ARMD by 25% and preserve vision by 19%.

Harvard researchers have found that patients consuming 5-7 servings of green, leafy vegetables which contain high levels of lutein and zeaxanthin, have a lower chance of developing macular degeneration. They comprise the two dominant yellow pigments in the macula, the center of our vision and the site where macular degeneration occurs and filter out visible blue light which may cause photodamage. Here, and also listed above, is a high quality supplement containing a rare blend of alpha-carotene, astaxanthin, beta-carotene, lutein, lycopene, and zeaxanthin delivering of a broad spectrum of carotenoids.   A sufficient dosage should be taken to provide 25,000 IU of beta carotene, per the AREDS recommendation.  Since oxidation and free radical damage is thought to contribute to ARMD (Age Related Macular Degeneration) supplementation clearly has it’s value.

The National Eye Foundation also encourages the use of daily multivitamins because they provide other essential nutrients not contained in the AREDS formulation.  These quality multivitamin formulas are well balanced and provide the 2 mg of copper that is recommended to prevent copper deficiency anemia, a condition associated with high levels of zinc intake.  The amounts of the key nutrients recommended by AREDS would be very difficult to obtain from diet alone.  Remember that no amount of vitamin supplements will take the place of a healthy diet, but they can be an important tool to increase nutrient levels and provide extra insurance.   Be aware that multivitamins that state they contain 100% of the minimum daily requirements: vitamin C 60mg, beta-carotene 5000 IU; vitamin E 30 IU; and zinc 15mg, are not sufficient.  These doses are far below that used in AREDS. Patients with AMD may need far more than the 100% daily requirements.  A multivitamin complements the AREDS formula, it does not replace it.

It is very important to recieve regular eye examinations from an eye care professional.  Early detection of macular degeneration is crucial in order to preserve vision.  For “dry AMD” the most common early sign is blurred vision. It becomes more difficult to see details in front of you, such as faces or words in a book. Often this blurred vision will go away in brighter light.  As AMD advances there becomes a blind spot in the middle of the field of vision, which will enlarge over time.  For “wet AMD” the classic early symptom is that straight lines appear crooked, caused by fluid from the leaking blood vessels behind the macula. A small blind spot may also appear resulting in loss of one’s central vision.  For more information, visit the Macular Degeneration Foundation.

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