Macular Degeneration: The Leading Cause of Age-Related Blindness
Age-related macular degeneration (AMD) affects the macula- the central most part of the retina, which is the inner layer at the back of the eye responsible for detailed central vision. The macula is used for reading, driving and recognizing people’s faces. Macular degeneration causes the center of your vision to blur or distort while the side or peripheral vision remains unaffected, however, early stages may have no symptoms. AMD is the leading cause of blindness in North American adults over the age of 55 reaching epidemic proportions as the population ages and people are living longer. 35% of the population will have this disease after the age of 75. While there is no cure, prevention and early detection can delay or reduce vision loss.
There are two types of AMD: dry and wet, with the dry form being more common. It is also the milder form, where there is a gradual degeneration of the central retinal tissues that make up the macula and symptoms generally develop slowly over time. The wet form is a sudden leakage, or bleeding, from weak blood vessels that have grown under the macula and symptoms progress rapidly. Wet AMD accounts for approximately 10 percent of all cases, but the dry form can develop into the wet form over time. An instrument called an optical coherence tomographer or OCT can help us look into these microscopic layers of the eye and determine if there are any early signs of new blood vessel growth indicating wet AMD that require treatment. It also allows us to take a photo to better monitor the condition.
In the earliest stages, macular degeneration is entirely symptom free but can be detected during a routi ne eye examination by your optometrist. The most common initial symptom is slightly wavy or distorted central vision when performing tasks that require seeing detail. This blurred spot or sense there is dirt in the way of clear vision cannot be corrected with eyewear. Over time, the damaged area may increase in size and interfere with reading and recognizing faces. There is no pain with AMD. Monitoring daily with a grid called an Amsler grid is recommended to catch any changes early. This should be done with reading glasses on and each eye separately, report any changes immediately.
Early detection is crucial as there is currently no cure for AMD. Dry AMD is treated with lifestyle modification like nutrition, exercise, wearing sunglasses to reduce UV/blue light and no longer smoking. Many cases of wet AMD can be treated with injection of anti-VEGF therapy into the eye to stop leaking blood vessels. This does not cure the disease but can help to slow or arrest progression. Ocular vitamin supplements are also proven to be beneficial. There was a 25% decrease in risk of dry moderate/severe AMD becoming wet AMD over a 5 year period with vitamins studied using the AREDS2 formula. Caution is recommended with the use of zinc at the AREDS2 level since it increases risk of some cancers and studies have shown that high levels of zinc are not necessary for the risk reduction. Genetic testing is starting to be studied to determine the best combination of vitamins for individuals.
Lifelong UV and blue light protection as well as good nutrition are believed to play key roles in preventing AMD. Living a healthy lifestyle by keeping your blood pressure down and reducing your intake of fatty foods, changing to whole grains and not smoking (avoiding second hand smoke) are all recommended. Genetics play a factor, but of course, this cannot be modified. A diet high in anti-oxidants, like those found in fruits such as blueberries and dark, leafy green vegetables, may help prevent AMD. Regular eye examinations are also important in the early detection.
Supplementation can be VERY confusing with too many choices. My recommendations for AMD are as follows:
Risk or Mild AMD:
MacuHealth – take one capsule daily.
Carotenoid supplements, such as those found in Macuhealth, contain three key components found in the macula– lutein, zeaxanthin and meso-zeaxanthin. While you can obtain the first two carotenoids through a balanced diet high in dark green leafy vegetables, meso-zeaxanthin is not found in sufficient dietary amounts thus the need for supplementation. Meso-zeaxanthin is created in the retina from conversion of ingested lutein. Macular degeneration patients have 30% less meso-zeaxanthin and may have the inability to adequately produce the required amount. Recent studies have proven that meso-zeaxanthin, if taken in a supplement, can effectively increase macular pigment levels and potentially arrest progression of the disease. Studies also show that there is a synergistic component to the carotenoids with the best combination being 10 mg lutein, 10 mg meso-zeaxanthin and 2 mg of zeaxanthin for macular pigment improvement.
MacuHealth is not available in stores due to the patent but available on-line at www.macuhealth.com or by phone 1-866-530-3222 or at our office for your convenience. If you decide to take an additional general multivitamin (besides the Preservision Lutein), ensure that it is taken at a different time of the day than MacuHealth to avoid competitive absorption and decrease efficacy of the product. Caution: if you have an allergy to sunflower seed extract.
For more information on macular pigment research:
For Moderate to severe AMD:
Vitalux Advanced – take 2 capsules a day with meals (do not crush but can be broken in half).
Take with meals to avoid gastric upset and they may be taken together or morning and night. Tip: It is best to wait a few hours before or after taking the vitamins before taking other medications. Generic versions of vitamins are not recommended.
MacuHealth – take one capsule daily. Macuhealth is recommended in addition to Preservision since it contains Meso-zeazanthin that adds a synergistic effect making the lutein and zeazanthin for effective in producing the protective macular pigment. It is not possible to overdose on the carotenoids.
UV and blue light protection:
It is recommended that everyone have UV and blue light protection. Blue light is impossible to escape. TV’s, Computers, smartphones, fluorescent light etc. all emit a significant proportion of blue light known as High-Energy Visible (HEV) light. While present in natural sources, blue light occurs in abnormal proportions in artificial light sources. Blue/HEV cover wavelengths from 380-500 nm and is toxic for the retina and can cause early cataract formation and AMD. Several manufacturers have realized the need to protect the retina and have created coatings to eliminate this wavelength of light. SeeCoat Blue by Nikon, Recharge by Hoya and Crizal Prevencia by Essilor all block HEV/blue light. These are designed to be added to the lens for indoor use. BluTech lenses are sunglasses that block blue light designed for outdoor use essentially giving a UV500 protection where normal sunglasses only give UV400 coverage.
Disclaimer: This information is for general purposes and may not be suitable to everyone, please discuss this with your optometrist if you have any concerns of questions.