Macular Degeneration


Age-Related Macular Degeneration (AMD)

Age-related macular degeneration (AMD) is a disease that gradually destroys sharp, central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving. AMD affects the macula, the part of the eye that allows you to see fine detail. AMD causes no pain.

In this simulation, how a person with AMD sees the world is presented graphically. As the disease progresses the area of central vision deteriorates. The gradual destruction of light sensitive cells continues until large areas are totally lost. Peripheral vision remains, but the ability to clearly see straight ahead is gradually lost. Credit: National Eye Institute, National Institutes of Health

In some cases, AMD advances so slowly that people notice little change in their vision. In others, the disease progresses faster and may lead to a loss of vision in both eyes. AMD is a leading cause of vision loss in Americans 60 years of age and older.

Wet AMD versus dry AMD

Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye. Damage to the macula occurs rapidly.

With wet AMD, loss of central vision can occur quickly. Wet AMD is also known as advanced AMD. It does not have stages like dry AMD.

An early symptom of wet AMD is that straight lines appear wavy. If you notice this condition or other changes to your vision, contact your eye care professional at once. You need a comprehensive dilated eye exam.

Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD gets worse, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision is gradually lost in the affected eye.

The most common symptom of dry AMD is slightly blurred vision. You may have difficulty recognizing faces. You may need more light for reading and other tasks. Dry AMD generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected.
 

Normal vision and the same scene as viewed by a person with age-related macular degeneration. Normal vision
Normal vision   The same scene as viewed by a person with age-related macular degeneration
The same scene as viewed by a person with age-related macular degeneration

Causes and Risk Factors

Who is at risk for AMD?

The greatest risk factor is age. Although AMD may occur during middle age, studies show that people over age 60 are clearly at greater risk than other age groups. For instance, a large study found that people in middle-age have about a 2 percent risk of getting AMD, but this risk increased to nearly 30 percent in those over age 75.

Other risk factors include:

  • Smoking. Smoking may increase the risk of AMD.
  • Obesity. Research studies suggest a link between obesity and the progression of early and intermediate stage AMD to advanced AMD.
  • Race. Whites are much more likely to lose vision from AMD than African Americans.
  • Family history. Those with immediate family members who have AMD are at a higher risk of developing the disease.
  • Gender. Women appear to be at greater risk than men.
  • Aspirin. A new study links daily aspirin use to an increased risk of macular degeneration.16

Can my lifestyle make a difference?

Diet and lifestyle can play a role in reducing your risk of developing AMD.

  • Eat a diet high in green leafy vegetables and fish.
  • Don’t smoke.
  • Avoid daily aspirin use.16

Conventional Medical Treatment for Macular Degeneration

Wet AMD can be treated with laser surgery, photodynamic therapy, and injections into the eye. None of these treatments is a cure for wet AMD. The disease and loss of vision may progress despite treatment.

  1. Laser surgery. This procedure uses a laser to destroy the fragile, leaky blood vessels. A high energy beam of light is aimed directly onto the new blood vessels and destroys them, preventing further loss of vision. However, laser treatment may also destroy some surrounding healthy tissue and some vision. Only a small percentage of people with wet AMD can be treated with laser surgery. Laser surgery is more effective if the leaky blood vessels have developed away from the fovea, the central part of the macula. (See illustration at the beginning of this document.) Laser surgery is performed in a doctor’s office or eye clinic.

    The risk of new blood vessels developing after laser treatment is high. Repeated treatments may be necessary. In some cases, vision loss may progress despite repeated treatments.

     

  2. Photodynamic therapy. A drug called verteporfin is injected into your arm. It travels throughout the body, including the new blood vessels in your eye. The drug tends to “stick” to the surface of new blood vessels. Next, a light is shined into your eye for about 90 seconds. The light activates the drug. The activated drug destroys the new blood vessels and leads to a slower rate of vision decline. Unlike laser surgery, this drug does not destroy surrounding healthy tissue. Because the drug is activated by light, you must avoid exposing your skin or eyes to direct sunlight or bright indoor light for five days after treatment.

    Photodynamic therapy is relatively painless. It takes about 20 minutes and can be performed in a doctor’s office.

    Photodynamic therapy slows the rate of vision loss. It does not stop vision loss or restore vision in eyes already damaged by advanced AMD. Treatment results often are temporary. You may need to be treated again.

     

  3. Injections. Wet AMD can now be treated with new drugs that are injected into the eye (anti-VEGF therapy). Abnormally high levels of a specific growth factor occur in eyes with wet AMD and promote the growth of abnormal new blood vessels. This drug treatment blocks the effects of the growth factor.

    You will need multiple injections that may be given as often as monthly. The eye is numbed before each injection. After the injection, you will remain in the doctor’s office for a while and your eye will be monitored. This drug treatment can help slow down vision loss from AMD and in some cases improve sight.

Nutritional Treatment of Age-Related Eye Disease Study (AREDS)

Age-Related Eye Disease Study (AREDS)

The National Eye Institute’s Age-Related Eye Disease Study (AREDS) found that taking a specific high-dose formulation of antioxidants and zinc reduces the risk of advanced AMD and its associated vision loss by 25%, slowing AMD’s progression from the intermediate stage to the advanced stage.

 The specific daily amounts of antioxidants and zinc used by the study researchers were 500 milligrams of vitamin C, 400 International Units of vitamin E, 15 milligrams of beta-carotene (often labeled as equivalent to 25,000 International Units of vitamin A), 80 milligrams of zinc as zinc oxide, and two milligrams of copper as cupric oxide. Copper was added to the AREDS formulation containing zinc to prevent copper deficiency anemia, a condition associated with high levels of zinc intake.

Can diet alone provide the same high levels of antioxidants and zinc as the AREDS formulation?

No. The high levels of vitamins and minerals are difficult to achieve from diet alone. However, previous studies have suggested that people who have diets rich in green leafy vegetables have a lower risk of developing AMD.

Can a daily multivitamin alone provide the same high levels of antioxidants and zinc as the AREDS formulation?

No. The formulation’s levels of antioxidants and zinc are considerably higher than the amounts in any daily multivitamin.

If you are already taking daily multivitamins and your doctor suggests you take the high-dose AREDS formulation, be sure to review all your vitamin supplements with your doctor before you begin. Because multivitamins contain many important vitamins not found in the AREDS formulation, you may want to take a multivitamin along with the AREDS formulation. For example, people with osteoporosis need to be particularly concerned about taking vitamin D, which is not in the AREDS formulation. 1

How to Make Vision Supplements Work Better

Many people who take the AERDS nutritional supplement formula do not benefit from it and the disease progresses. Only about 25% of study participants benefited. Also note that this formula often slows the advancement of the disease. Just because you don’t notice improvement doesn’t mean it isn’t working.

Some holistic physicians, myself included, have found that poor assimilation — especially a decrease of gastric acid function in the stomach — is an important factor in the development of AMD. No matter how many supplements one takes, if they are not assimilated, they are of no value.

It is probably no coincidence that the risk of AMD increases with age and so does the decline of stomach acid production. Contrary to popular belief, most people who experience “heartburn” actually have too little stomach acid, not too much. Find out how that happens in this article: What’s Burning You?

So, in addition to taking eye nutrients, improving digestion and assimilation is also highly recommended.

Dr. Myatt’s Recommendations for Macular Degeneration

  1. Diet: eat a diet high in antioxidant nutrients (especially green vegetables), high in Omega-3 fatty acids (from fish) and low in Omega-6 fatty acids.
  2. Gastric function: Perform a Gastric Acid Self-Test or ask your holistic physician to perform a Heidleberg gastric analysis. Make corrections to gastric acid function as indicated by the test.
  3. Vision supplements: The following are specifically recommended for macular degeneration:

    I) Maxi Multi– optimal potency multiple vitamin / mineral / trace mineral supplement. 3 caps, 3 times per day with meals.

    Vision was the same or better in 88% of people with AMD who took a multiple vitamin / mineral supplement compared with 59% of those who those who did not take the supplement. This is a statistically significant difference. The supplement used in this study contained beta-carotene, vitamin C, vitamin E, zinc, copper, manganese, selenium, and riboflavin. 2  Other studies have confirmed the importance of vitamins A, C, E, zinc and other nutrients found in a quality multiple vitamin/ mineral formula. 3,5 More recent studies have also shown the importance of B complex vitamins in AMD.4

    II.) Maxi Marine O-3: (high potency fish oil). 1 cap, 2 times per day. A diet high in omega-3 fatty acids, especially from fish oil, has been associated with lower risk of macular degeneration in multiple studies. 5-10

    III.)  Lutein Plus (lutein and zeaxanthin).  1 cap, 1-2 times per day with meals. Lutein and zeaxanthin are two carotenoids that act directly in the macula to protect it from damaging effects of excess light.  Along with vitamins C and E, they are part of the antioxidant defense system of the macula.11      

    Studies have shown that lutein and zeaxanthin reduce the risk of AMD and may slow progression. 3-5, 11-14
    Smokers have an increased need for these carotenoids. 14      

How Long to See Results?

One study suggests that it takes at least 6 months of supplementation to see results. 15
 

References

  1. www.nei.nih.gov
  2. Olson RJ. Supplemental dietary antioxidant vitamins and minerals in patients with macular degeneration. J Am Coll Nutr 1991;10:550.
  3. Krishnadev N, Meleth AD, Chew EY. Nutritional supplements for age-related macular degeneration. Curr Opin Ophthalmol. 2010 May;21(3):184-9.
  4. Olson JH, Erie JC, Bakri SJ. Nutritional supplementation and age-related macular degeneration. Semin Ophthalmol. 2011 May; 26(3):131-6.
  5. Ho L, van Leeuwen R, Witteman JC, van Duijn CM, Uitterlinden AG, Hofman A, de Jong PT, Vingerling JR, Klaver CC. Reducing the genetic risk of age-related macular degeneration with dietary antioxidants, zinc, and ω-3 fatty acids: the Rotterdam study. Arch Ophthalmol. 2011 Jun;129(6):758-66.
  6. Mance TC, Kovacević D, Alpeza-Dunato Z, Stroligo MN, Brumini G. The role of omega 6 to omega 3 ratio in development and progression of age-related macular degeneration.Coll Antropol. 2011 Sep;35 Suppl 2:307-10.
  7. Merle B, Delyfer MN, Korobelnik JF, Rougier MB, Colin J, Malet F, Féart C, Le Goff M, Dartigues JF, Barberger-Gateau P, Delcourt C. Dietary omega-3 fatty acids and the risk for age-related maculopathy: the Alienor Study. Invest Ophthalmol Vis Sci. 2011 Jul 29;52(8):6004-11. Print 2011 Jul.
  8. Sangiovanni JP, Agrón E, Meleth AD, Reed GF, Sperduto RD, Clemons TE, Chew EY; Age-Related Eye Disease Study Research Group. {omega}-3 Long-chain polyunsaturated fatty acid intake and 12-y incidence of neovascular age-related macular degeneration and central geographic atrophy: AREDS report 30, a prospective cohort study from the Age-Related Eye Disease Study. Am J Clin Nutr. 2009 Dec;90(6):1601-7. Epub 2009 Oct 7.
  9. SanGiovanni JP, Chew EY, Agrón E, Clemons TE, Ferris FL 3rd, Gensler G, Lindblad AS, Milton RC, Seddon JM, Klein R, Sperduto RD; Age-Related Eye Disease Study Research Group. The relationship of dietary omega-3 long-chain polyunsaturated fatty acid intake with incident age-related macular degeneration: AREDS report no. 23. Arch Ophthalmol. 2008 Sep;126(9):1274-9.
  10. Seddon JM, Rosner B, Sperduto RD, Yannuzzi L, Haller JA, Blair NP, Willett W. Dietary fat and risk for advanced age-related macular degeneration. Arch Ophthalmol. 2001 Aug;119(8):1191-9.
  11. Fletcher AE. Free radicals, antioxidants and eye diseases: evidence from epidemiological studies on cataract and age-related macular degeneration. Ophthalmic Res. 2010;44(3):191-8. Epub 2010 Sep 9.
  12. SanGiovanni JP, Chew EY, Clemons TE, Ferris FL 3rd, Gensler G, Lindblad AS, Milton RC, Seddon JM, Sperduto RD. The relationship of dietary carotenoid and vitamin A, E, and C intake with age-related macular degeneration in a case-control study: AREDS Report No. 22.  Arch Ophthalmol. 2007 Sep;125(9):1225-32.
  13. Tan JS, Wang JJ, Flood V, Rochtchina E, Smith W, Mitchell P. Dietary antioxidants and the long-term incidence of age-related macular degeneration: the Blue Mountains Eye Study.Ophthalmology. 2008 Feb;115(2):334-41. Epub 2007 Jul 30.
  14. Schweigert FJ, Reimann J. [Micronutrients and their relevance for the eye–function of lutein, zeaxanthin and omega-3 fatty acids]. Klin Monbl Augenheilkd. 2011 Jun;228(6):537-43. Epub 2010 Aug 25.
  15. Cangemi FE. TOZAL Study: an open case control study of an oral antioxidant and omega-3 supplement for dry AMD. BMC Ophthalmol. 2007 Feb 26;7:3.
  16. Paulus T.V.M. de Jong, Usha Chakravarthy, Mati Rahu, Johan Seland, Gisele Soubrane, Fotis Topouzis, Johannes R. Vingerling, Jesus Vioque, Ian Young, Astrid E. Fletcher. Associations between Aspirin Use and Aging Macula Disorder:The European Eye Study. Ophthalmology Volume 119, Issue 1 , Pages 112-118, January 2012