Prevention of Macular Degeneration

Prevention of Macular Degeneration is the Best Medicine

Macular Degeneration Can Lead to Blindness and Despair

Macular degeneration (AMD) is a chronic, progressive eye disease that is caused by degeneration of the central retina area called the macula. It is a devastating human disease that can lead to central blindness. In many cases it robs a person of the ability to live an independent life. Many people lose the ability to drive, to read and to see any fine detail at far or near. Even the ability to see clearly a loved one’s face can be destroyed. The human toll is a very emotional loss that can also cause depression and lead to loneliness, despair and withdrawal.

Because macular degeneration is so common and because it is predicted to increase by 300% over the next 20 years due to an ever aging baby boom population, people need to take important steps to prevent or reduce the chances of acquiring this dreadful disease.

Although increased age is a significant risk factor, macular degeneration is a result of years of cumulative retinal degeneration that begins very early in life. Young people need to be aware of this condition and adjust their lifestyle to minimize the chances of being stricken with this dreaded disease.

Prevalence of Macular Degeneration

Macular degeneration is the leading cause of irreversible blindness in the world. Approximately 1.5 million new cases of macular degeneration are diagnosed every year in North America! More people will go blind from macular degeneration than from cataracts and glaucoma combined.

The current estimate of the number of people with macular degeneration in North America is about 15 million. The Center for Disease Control predicts that number will double by 2020.

What is the Macula?

The macula is the small central area of the retina and is responsible for our clearest visual acuity. In the center of the macula is the fovea, which is a tiny area of depression that contains the highest concentration of cone photoreceptor cells in the eye. The fovea provides the highest resolution vision that a human eye can obtain. 20/20 or 20/15 visual acuity is only possible at the macula. Visual acuity declines in the retina periphery.

For a comprehensive review of the macula click here.

What are Carotenoids and Macular Pigment?

The macula is slightly yellow in color due to the yellow xanthophyll carotenoids known as lutein and zeazanthin that are present in the macula. These carotenoids are known as the macular pigment. Carotenoids are phytochemicals found in plants. These carotenoids are commonly found in certain fruits and vegetables. The carotenoids lutein and zeazanthin often provide a red, orange and yellow color to foods. Another carotenoid found to a lesser extent in the macula is called meso-zeazanthin. It is not found in foods but is actually created within the macula itself by an enzyme conversion of lutein into meso-zeazanthin.

Zeazanthin is concentrated primarily in the macula while lutein dominates other parts of the retina.

Physiology of Macular Degeneration

It is first important to understand the physiological mechanism that occurs that leads to macular degeneration. The cause of macular degeneration is not completely known. However, we do have a very good understanding of what happens to the retina when it occurs. Two very probable causes of macular degeneration are oxidative damage from ultraviolet and high-energy blue light (wavelengths 400-475 nanometers); and reactive oxygen damage from free radicals, photochemical reactions and normal cell metabolism.

High oxygen levels in the macula along with a very high rate of metabolism create an exceptionally high amount of oxidative stress. If the oxidative rate is higher than the available antioxidants can neutralize, there is photoreceptor (rods and cones) oxidation and damage to the cells.

The primary deterioration in macular degeneration appears to be in two layers of the retina, the photoreceptors and the retinal pigment epithelium. Beginning essentially at birth and continuing throughout life, cells of the retinal pigment epithelium layer accumulate cell debris. The damaged cells that remain (called lipofuscin) from the oxidative stress accumulate in Bruch’s membrane and create drusen, which is the earliest visible sign of dry macular degeneration. The lipofuscin/drusen is a cluster of protein and oxidized lipids that do not degrade. It is possible that the oxidation induces inflammation that can continue to worsen the entire macular degeneration process.

Preventing Macular Degeneration

Preventing AMD or reducing the chances of developing vision loss from AMD involves protecting the layers of the central retina from oxidative damage. Oxidative damage is cumulative beginning early in life. Anything that prevents or minimizes the oxidative damage of the macula will prevent or minimize macular degeneration.

Macular Protective Pigments Prevent or Reduce AMD by Filtering Light that Causes Damage and as Antioxidants they Neutralize Free Radicals

There are multiple risk factors for developing macular degeneration. We will concentrate here on low levels of macular pigment density and later discuss other risk factors.

The macular area of the retina is thinner than other retinal areas. Therefore, incoming light reaches the rods and cones more directly. When the macula is exposed to high energy blue light (400-475 nanometers wavelength) and ultraviolet light for a long cumulative period of time irreversible damage occurs to the delicate tissue of the macula and fovea.

The macular pigments, lutein, zeazanthin and mesozeazanthin, absorb light of that wavelength very effectively. The macular pigments essentially form a shield within the retina to protect the underlying macular layers (rods and cones) from ultraviolet and high energy blue light. The damaging light causes free radicals from the oxidative damage. These pigments filter the damaging light by as much as 95%. However, to filter the damaging light there has to be a significant density of the macular pigments. If the macular pigment density is low the damaging ultraviolet and high energy blue light create oxidative damage to the cells of the macula. Macular pigment (MP) density varies greatly from one individual to another. In addition to the normal age-related reduction of macular pigment, MP density is related to genetic make-up, prior history of light exposure, diet and lifestyle factors.

In addition to filtering the light that causes oxidative damage, lutein and zeazanthin are potent antioxidants that protect against oxidative damage caused by oxygen metabolism and normal cellular processes. The damaging molecules created through the normal body functions are called free radicals. Anti-oxidants work to neutralize the free radicals. Free radicals can also be produced by the environment. Such things as toxins, air pollution, radiation and cigarette smoke also create free radicals.

Proof that Macular Pigments Protect Against Macular Degeneration

There is extensive and lengthy research on macular degeneration. The largest study conducted to date was called the Age Related Eye Disease Study or AREDS for short. The AREDS study was sponsored by the U.S. government’s National Eye Institute and lasted approximately 10 years.

The AREDS formula of nutritional supplements was:

Vitamin C 500mg
Vitamin E 400 IU
Beta Carotene 15mg (equivalent to Vitamin A 25,000 IU)
Zinc 80mg (zinc oxide)
Copper 2mg (cupric oxide) added solely to prevent copper deficient anemia caused by too much zinc

According to the NEI website:

The AREDS study found that taking high levels of antioxidants and zinc can reduce the risk of developing advanced age-related macular degeneration (AMD) by about 25 percent.

This major clinical trial closely followed about 3,600 participants with varying stages of AMD. The results showed that the AREDS formulation may play a key role in helping people at high risk for developing advanced AMD keep their remaining vision.

AREDS proved that nutritional supplements could slow progression of macular degeneration in patients with intermediate AMD. AMD patients on nutrition supplements had a decreased risk of progressing to more advanced stages of AMD.

The AREDS study concluded in 2006. Since then additional research has provided additional and important information:

Large clinical trials sponsored by the National Cancer Institute demonstrated that large doses of beta-carotene increases the risk of lung cancer in current smokers.
New research shows that depletion of the macular pigments, lutein and zeazanthin, is now thought to be a major cause of macular degeneration
It is possible to increase macular pigment density with potent nutritional supplements of carotenoids (lutein and zeazanthin)

AREDS 2 STUDY

With this new knowledge a second study is underway by the National Eye Institute called AREDS 2. The new study has added lutein and zeazanthin along with Omega-3 essential fatty acids to the supplement mix.

Zeazanthin is the Most Important Eye Nutrient

A recent study has shown that dietary zeazanthin normalizes the angiogenesis (formation of new blood vessels) causing VEGF factor, which is responsible for the sight threatening transition from dry macular degeneration into neovascular/wet macular degeneration. This explains why high dietary intake of zeazanthin reduces the chances of developing the most severe form of macular degeneration.

Many studies have concluded that dietary lutein and zeazanthin have protective effects on the macula. However, there have been four studies since 2003 that have shown that it is the zeazanthin that may be more important to protecting the macula from degeneration. In 2006 a French study (POLA) found that high levels of serum zeazanthin reduced macular degeneration by 93%. These results were significantly greater than for serum lutein. In 2008 another large European study (Eureye) concluded that low levels of zeazanthin and high levels of ultraviolet exposure combined to increase the chances of macular degeneration by 400%!

Meso Zeazanthin

There is confusion in the marketplace by the introduction of non-dietary meso-zeaxanthin. Meso-zeaxanthin is found only in the human retina, not in the human diet or blood. Research in primates has shown that mesozeazanthin is created in the macula by lutein. It is unknown what the dietary supplementation of mesozeazanthin does for the macula. Meso-zeaxanthin is sourced from outside the U.S. and is manufactured by harsh chemical treatment of lutein. The FDA has reviewed the safety of lutein and dietary zeaxanthin multiple times but has not studied the supplementation of meso-zeazanthin.

Nutritional Supplements for Macula Health

The bioavailability and stability of lutein and zeazanthin are highly sensitive to the formulation and manufacturing. Therefore, not all supplements are created equal. The same amount of lutein or zeazanthin in different supplements will usually not be equal - one product will be superior in its bioavailability to the body.

Zeaxanthin is very scarce in the average US daily diet.

Zeaxanthin is very scarce in the average US daily diet. A higher intake of the carotenoids lutein and zeaxanthin along with several other essential vitamins such as Vitamin C, E and D3 plus zinc and omega 3’s could help improve vision.

While the body actually produces a natural 2:1 ratio of Zeaxanthin to Lutein in the fovea, it is very difficult to replenish Zeaxanthin levels through a regular daily diet.

Fact: It would take nearly 20 ears of corn to equal the 8mg of Zeaxanthin found in an EyePromise Restore Formula softgel.

EyePromise has the right mix of ingredients and eye vitamins and is scientifically demonstrated to be helpful for healthy vision. Eye Promise is one of the nutritional supplements that is recommended by Master Eye Associates.

Genetic Testing for AMD

A gene mutation known as Complement Factor H Gene may increase the risk of developing AMD. Some believe that the risk of developing AMD increases 2.5-5X if this gene variant is present.

A genetic test is now available to assess one’s likelihood of being affected by macular degeneration. With genetics playing a significant role in whether a person develops the disease the test is valuable. However, AMD is a complex condition with multiple causes, genetics being only one of those. Some people never develop AMD, even though both parents have it and vice-versa. At this point the genetic tests do not determine precisely whether an individual will develop macular degeneration.

The best way to determine risk of developing macular degeneration is by a comprehensive exam of the central retina by an eye doctor. The first signs of macular degeneration are drusen. The quantity and size of drusen will tell the eye doctor a lot about your risk of vision loss from AMD.

Master Eye Associates

Macular Health Center

Focuses on Prevention & Early Detection of Macular Degeneration

For patients with NO macular degeneration:

Measure, Manage, Monitor and Maintain

Measure Macular Pigment Level
Manage using patient education and awareness along with a Comprehensive Risk Assessment and Nutrition Counseling. Rx of supplements when needed.
Monitor every 6 months for patients with low levels of macular pigment
Maintain healthy macular protective pigment levels and all other risk factors

For patients with early macular degeneration or drusen, the following steps would occur before the above:

Detection of Macular Degeneration

Evaluate extensively to assess the stage of macular degeneration

Possible Diagnostic Tests include:

a. Ocular Coherence Tomography (OCT) retina scan to view the level of damage.

OCT retina scan below identifies early and small drusen in early AMD

b. Retinal photography to establish baseline readings

c. Visual acuity readings to assess quality of vision

d. Amsler Grid to evaluate image distortion

e. Visual Fields to assess lost areas of vision

f. Heterochromatic flicker photometer to measure macular protective pigment density

g. Fluorescein angiography when needed to evaluate for wet/neovascular AMD

Master Eye Associates Risk Assessment

Counseling for Macular Degeneration

Steps for Preventing or Reducing Macular Degeneration Risk

1. Take Nutritional Supplements

Choose professional pharmaceutical grade products with high levels of zeazanthin and a lesser amount of lutein. Other ingredients should be Omega 3’s, Vitamins C, E and D3, Alpha Lipoic Acid and zinc.

2. DO NOT SMOKE

Smokers are 300%-500% more likely to develop macular degeneration than non-smokers! No second hand smoke either!

3. Wear Sunglasses that Block Ultraviolet and Blue Light (400-475 nm)

4. Eat Dark Green Leafy vegetables and other yellow, orange and red vegetables

Such as spinach, lettuce, kale and collard greens, corn, red and yellow peppers. These provide carotenoid nutrients such as lutein and zeazanthin that are absolutely necessary to build macular protective pigment density.

5. Eat Fish

Cold water fish especially salmon to provide the highest levels of Omega 3’s to reduce inflammation.

6. Eat Fruits and Nuts

7. Control Blood Pressure, Cholesterol and Blood Sugar

Avoid high glycemic index foods such as white bread, pretzels, donuts and other sweets
Blood pressure must be monitored and treated if not within normal range
Cholesterol must also be monitored and treated if not within normal range

8. Exercise Regularly and Maintain a Lean Body Mass

9. Have Your Eyes Examined Every Year

Make sure your eye doctor has the newest OCT technology.