Nutrition and Vision: Eating Right and Seeing Better

Maintaining proper nutrition for optimum general health is something that we’ve all heard for many years. It makes sense that what we eat affects how our bodies function and survive. However, until recently little has been said about how nutrition affects our eyes and visual system.

Consider that the eyes are as much a part of the body as any other organ. There are literally millions of nerve endings that serve as a part of the visual process. The eye really is an extension of the brain, and while the eye and brain only make up 2% of body weight, they require about 25% of the nutritional input. So proper nutrition of the eyes is important to not only maintain proper vision but also eye health as well.

This article excerpts Dr. Anshel’s book, “Smart Medicine For Your Eyes” and will discuss various eye conditions that occur and how to deal with them, both conventionally and with nutritional support. Please realize that diagnosing vision conditions requires the expertise of qualified eyecare professionals, so this information is to be used in conjunction with your eye doctor’s efforts. Be sure to work closely with your doctor to assure that all of the steps you are taking are toward achieving the proper goal.

Macular Degeneration

The macula is the area of the retina that is the most sensitive and is used for direct, central vision. For one in four people over the age of sixty-five and one in three over the age of eighty, the macula begins to degenerate (deteriorate), therefore this condition is known as age-related macular degeneration (AMD, or AMD). Very often the macular area of one eye shows this degenerative change while the other eye is perfectly normal. In this circumstance, you may not notice that the change is taking place because the good eye will dominate your vision.

There are two types of AMD: the wet and dry forms. The wet form accounts for only 10% of the cases. It occurs when tiny, new abnormal blood vessels begin to grow behind the retina toward the macula. Here they often leak blood and fluid that damage the macula, causing rapid and severe vision loss. The dry form constitutes the other 90% of cases and occurs when small yellowish deposits called drusen (DROO-zin) start to accumulate beneath the macula. These deposits gradually break down the light-sensing cells in the macula, normally causing distorted vision in the eye.

Total blindness doesn't occur with macular degeneration. Since the macular area is only responsible for central vision, only this area will be affected. However, a person afflicted with macular degeneration can feel very helpless and frustrated due to the loss of detail vision. Peripheral vision usually remains intact and therefore allows a person to function almost normally, especially if only one eye is involved.

There are certain risk factors that can make one more susceptible to AMD. Those are:

Age- it is estimated that about 14% of people aged 55-64 have some form of AMD. This rises to about 25% of 65 to75 year-olds and up to 37% of those over 75.

Diet and Nutrition- the macula’s fragile cells are highly susceptible to damage from oxygen-charged molecules called free radicals. Early research has shown that people with a low dietary intake of antioxidants may be at risk of developing AMD. Alcohol may also deplete the body of antioxidants. High levels of saturated fats and low –density (LDL) cholesterol harm blood vessels and are also involved in producing free radicals reactions that can damage the macula.

Sunlight- The cells of the macula are highly sensitive to sunlight. Cell damage from the sun can lead, over time, to deterioration of the macula. People with light colored eyes may be more prone to damage from sunlight, as are those who have prolonged exposure to ultraviolet light.

Smoking- A recent study showed that smoking, which reduces protective antioxidants in the eye, more than doubles the risk of AMD. The study found that AMD is more than twice as common in people who smoke more than one pack of cigarettes a day, compared with people who do not smoke, and the risk remains high even up to 15 years after quitting.

Heredity- Some studies show that AMD may be in part inherited. This means that if you have one or more immediate relatives with AMD, you may be at higher risk to develop the condition.

Gender and Race- Being a women over age 75 doubles your chances of developing AMD compared to a man of the same age. Low levels of estrogen in post-menopausal women may also increase risk for the condition. There is some suggestion that post-menopausal estrogen therapy may be protective or AMD, but more research is needed in that area. Women also live longer than men. Caucasians are much more likely than African Americans to lose vision to AMD.

Heart Disease- If you have high blood pressure or another form of heart disease, you may also have a greater chance of getting AMD because of poor blood circulation to the eyes.

Conventional Treatment

Lasers have been used in the treatment of the “wet” form of macular degeneration. In this procedure, the laser can be used to coagulate (clot) the tiny blood vessels that have grown near the macula. Unfortunately, most forms of the problem cannot yet be reliably treated either medically or surgically. Special low-vision aids can be of great help to those with macular degeneration. These aids serve to magnify images so they are spread over a larger portion of the retina.

Most doctors will administer a test called an “Amsler Grid”. This test will be valuable in following the course of the disease process but certainly does nothing to resolve the condition.

More recently there has been the development of certain light-enhanced treatment for AMD, called Photo-Dynamic Therapy (PDT). This process involves injection a solution into the veins, then shining a light into the eyes that will allow this solution to block the development of new blood vessels. This procedure is designed for the “wet” form of AMD. New studies are continuing to look at several other forms of PDT, but little is on the horizon for the “dry” form of the disease.

Self Treatment

While you cannot change your age, your sex or your family tree, there are some lifestyle changes you should adopt to help protect your eyes. First, wear sunglasses or a brimmed hat when exposed to large amounts of ultraviolet light. Moderate amounts of ultraviolet light are good for the human body but overexposure can cause damage to some parts of the eye.

Anything that prevents the clogging of your arteries may help prevent macular degeneration (as well as the degeneration of the rest of your body). Therefore, watching your dietary fat and cholesterol, exercising regularly, not smoking and watching your weight and blood pressure are wise moves. Limit your intake of alcohol to a maximum of six drinks per week for men and three for women.

Finally most doctors are finally recommending that their older patients take antioxidant supplements to prevent or halt the progress of macular degeneration. Recent studies indicate that a well-rounded combination of antioxidants has shown to slow macular degenerative changes. Several research studies on AMD are focusing on the role of a group of antioxidants called carotenoids (care-OTT-ten-oyds). Two of these, lutein (LOO-teen) and zeaxanthin (zee-ah-ZAN-thin), are the only pigments found in the macula. By contrast, beta carotene is virtually absent in the eye (although it’s cousin, Vitamin A, is plentiful in the retina). Lutein and zeaxanthin can be found in almost all fruits and vegetables, but are most likely to be in dark green, leafy vegetables such as spinach and collard greens. Another study among male veterans showed that increasing antioxidants could slow the progression of vision loss from dry AMD. For more specific information, consider the formulations by Biosyntrx (www.biosyntrx.com).

NUTRITIONAL SUPPLEMENTS

Cataract

A cataract (CAT-ah-rackt) is a clouding of the lens within the eye. This clouding can be partial or complete, so not all cataracts interfere very much with vision. However, the type of cataract that occurs with advancing age is generally progressive, so that a small cataract that doesn’t cause much of a problem will probably become a large cataract that obscures vision at some point, perhaps a few years down the road.

            Cataracts are not limited to the aged, although so-called ‘senile’ cataracts are the most common type of cataract. The National Eye Institute estimates that by age 80, more than half of all Americans either have a cataract or have had cataract surgery. It also estimates that cataracts affect more than 20.5 million Americans age 40 and over, or about one in every six people in this age range.

            You may have heard that cataracts can also be present at birth. They can happen, though it’s pretty rare. They’re called ‘congenital’ and are sometimes caused by the mother’s having contracted German measles, mumps, chickenpox or certain other infectious diseases during her pregnancy; they can also be inherited.

            Some diseases, injuries and a class of anti-inflammatory drugs called steroids can also cause cataracts at any time of life. You can also develop a cataract after being exposed to radiation (from many X rays, for example), from constant exposure to infrared light (called “glassblower’s cataract” because this profession used to work with infrared light without eye protection) or from being hit with a high-voltage current (lightning or electrocution) through the head. (Of course, if you’re struck by lightning or electrocuted, cataracts would probably be the least of your concerns!) Recent research suggests that many years of extreme exposure to ultraviolet light (UV), which is part of sunlight but is beyond the human visible spectrum, can also play a part in the development of cataracts. This is because the lens is a UV filter and absorbs most of the UV light entering the eye so that none of it reaches the retina. Another study suggests that cigarette smoking may be linked to the formation of cataracts; the eye damage seems to be from the effect of certain chemicals being transported internally to the lens when the person smokes, not from smoke in the environment.

            So, you may wonder, are cataracts an inevitable consequence of advancing age, or are they the result of some action that can be changed?

            Researchers in the field of aging are asking this question about many conditions previously thought to be the unavoidable price of living a long life. The answer with cataracts, as with most conditions, is that they are probably a combination of the aging process and the environment in which the person has been living for many years. Years of exposure to ultraviolet light, radiation and various as-yet-unidentified environmental “insults,” such as smoking, eventually catch up with us as we age; at the same time, the eye’s lens fibers begin to break down and are more vulnerable to stresses from the outside world. You may be able to prevent or postpone the development of a cataract by protecting your eyes against ultraviolet light with a good pair of sunglasses, eating a nutritious and balanced diet, limiting your exposure to infrared light and radiation from X-rays and other sources, and by not smoking.

Conventional Treatment

            When the cataract is interfering significantly with your vision and your life, it’s usually time to consider surgery (not every cataract gets to this point). Cataract surgery currently is the most frequently performed surgical procedure in the United States, with more than 1.5 million people having cataract surgery each year. Worldwide, an estimated 8.7 million cataract procedures are performed annually. You may have heard that you have to wait until a cataract is “ripe” before it can be surgically removed. This was true years ago, but new surgical techniques have made it possible to remove a cataract at any time as long as your doctor feels you are in good enough shape to undergo surgery. A few different surgical techniques can be used, and you and your surgeon can decide which one is best for you. Sometimes, cataract surgery can be done as an outpatient procedure.

A recent study by a group in Spain found a relationship between estrogen and cataracts. It found that women who had been taking estrogen for more than four years had a reduced number of opacities in the lenses of their eyes. Although this is only one study, it might be worth a look at why this happens.

Self Treatment

            If you do develop a cataract, you won’t necessarily need surgery, at least not right away. What you’ll notice with your cataract is that light is refracted differently now and doesn’t look the same as it did before. You may see just a general sort of cloudy haze in your visual field, or you may see a “dazzling” effect of scattered light as it bounces off your cataract. Changes in how you see are almost always due to changes in the lighting around you.

            Outdoors on a sunny day, you will probably want to wear a hat with a brim to reduce this dazzle effect of bright sunlight; sunglasses will help this too. Indoors, experiment with the best lighting for you. You’ll find reading easier if you have a small reading lamp that can be moved around and adjusted for your comfort instead of a bright, immovable ceiling fixture. You may want to keep the room lighting low (but not off) when you watch television.

There have been many reports of nutritional support to fend off cataracts. It has been experimentally shown that diets low in vitamin B-2 can produce cataracts in animals. Cataracts in horses, a common cause of blindness in these animals, can be reduced when large amounts of vitamin B-2 are added to the diet. Galactose or milk sugar increases the need for vitamin B-2. In infants who cannot utilize galactose normally, blindness from cataracts has been corrected when milk sugar has been withdrawn from their diet and vitamin B-2 added. A 1997 study found a significant reduction in cataracts in a group of nurses who took vitamin C supplements. It is apparent that except for those cases of cataracts that are strictly and totally congenital, the major factor in the etiology of cataracts is nutrition. Although the lens can now be replaced by an artificial one, the best lens to have in your eye is the one that is already there!

NUTRITIONAL SUPPLEMENTS

Dry Eye Syndrome

Dry eye syndrome is a problem with either the quantity or quality of the tear film leading to symptoms of dry, red, burning, gritty, or watery eyes. The eyes may be very light sensitive. Dry eye syndrome is not so much a disease but a group of symptoms that develop as a result of other conditions such as eye allergy, medications, arthritis, and environmental factors such as low humidity.

To understand dry eyes, one must first understand the function and components of the tear film. There are three layers of tears on the front of the eye: the oily layer is outermost. It is produced by glands called meibomian (my-BOHM-ee-an) glands, primarily located in the eyelids. It reduces tear evaporation. The second layer is the watery middle layer, which comprises the majority of the thickness of the tear film. This tear layer is produced by the lacrimal (LAK-ri-mal) gland located under the brow bone. This is the watery type of tear that is produced in copious amounts when we cut an onion and our eyes become watery. The innermost layer, which is called the mucin (MEW-sin) layer, is produced by the cells in the conjunctiva (the clear coating over the white of the eyes).

Many dry eye sufferers have watery eyes and don't understand how their eyes can be running with moisture and yet their doctor diagnoses their problem as “dry” eye. This can be explained as a dry eye where the tear glands pump extra amounts of watery tears on the eyes as a protective mechanism to compensate for the dry condition. Eyes that are constantly watery may also have a blocked tear duct.

 Dry eye is probably the most common of all eye problems. A recent Harris Poll indicates 33 million U.S. adults are affected by dry eyes, and 89 percent of Americans are unfamiliar with what is probably the most common of all eye disorders.

    Adults who have arthritis and other autoimmune disorders are more likely to have dry eyes. Dry eyes accompanied by dry mouth (difficulty swallowing) is called Sjogren’s (SHOW-grins) Syndrome, a condition that occurs more commonly (90%) among women past age forty. In Sjogren’s syndrome, the body’s immune system mistakes its own moisture producing glands for foreign invaders. The immune system then attacks and destroys these glands causing the hallmark symptoms of dry eyes and dry mouth. Like Lupus, Sjogren’s can also damage vital organs of the body with symptoms that may plateau, worsen or go into remission. Some people may only experience the mild symptoms of dry eyes and mouth, while others go through cycles of good health followed by severe disease.

The eyes produce about 40 percent less moisture with advancing age. Certain medications may interfere with tear production (see below). Droopy lower eyelids, as well as excessive computer viewing (decreased blink rate), may expose the surface of the eyes to the air, increasing evaporation and dry eye symptoms.

Conventional Treatment

The first treatment for dry eyes is artificial tears. There are many types of eye drop preparations. It is advisable to avoid artificial tears that have preservatives. Preservatives eventually make your dry eye condition worse. Most preservative-free eye drops come in individual dose vials and you can conveniently carry them around in your pocket or purse. Some of the more viscous (thicker) eye drops last longer on the eye, but your vision is likely to be a little foggy for the first few minutes after putting them in your eyes.

There is no known cure for Sjogren’s syndrome. Moisture replacement therapies can ease the symptoms of dryness. Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids and disease modifying drugs are often used to treat Sjogren’s. Studies by scientists indicate that the male hormone androgen may restore lacrimal gland function and relieve chronic dry eye symptoms. There are some side effects, such as virilism- the growth of facial hair and the manifestation of other male characteristics- in women. Further studies are being conducted to identify an androgen compound that would prevent these side effects.

One of the most practical methods of treating a conventional dry eye is to plug the hole in the tear “sink.” There are tear drainage canals on the edges of the upper and lower eyelids near the nose area. Inside the drainage opening in the lids are tiny pumps that suck away fluid from the surface of the eyes. The lacrimal glands behind the eyelids produce tears. The eyelids spread the tears across the eye's surface, much like a windshield wiper. The drain at the bottom permits the fluid to drain away. If the drain is plugged, more fluid stays on the surface of the eyes. The main problem with this procedure is that, if the tears are “faulty” and lead to inflammation (a major cause of dry eyes), then allowing the inflammatory tears to stay in contact with the eyes longer can actually make the condition worse.

Self Treatment

To help conserve moisture on the surface of the eyes, consider some of the following measures:

· Use humidifiers in the home, especially in dry, desert areas.

· Wear wrap-around sun goggles outdoors: Sunglasses (or even clear goggles) with side shields help reduce evaporation by as much as 40 percent.

· Blink your eyes: As you blink you squeeze tears from the glands in your eyelids. Waiting 20-30 seconds in between blinks may cause the breakup of tear film and dehydration.

· Stop smoking: When cigarette smoke is introduced to a room, dry spots on the surface of the eyes occur 40 percent faster than when the lids are held open.

· Avoid smog and fumes: These eye irritants inactivate the enzyme that acts as an antibacterial agent in the tear fluid.

· Check the nose pads on your eyeglasses: If the nose pads are pushing the lower eyelids down they may increase the evaporation of tears. Have an optician adjust the nose pads.

· Tilt the computer monitor: When using a computer terminal, lower the monitor so that the opening in the eyes will be narrow when viewing the screen, thus reducing the surface area of the eyes exposed to the air. See Computer Vision Syndrome sections in this web site.

· Reduce, replace or avoid eye makeup: Eye makeup has been shown to thin the fatty layer on the outer surface of the tear film that keeps the eyes from dehydrating quickly. Eye makeup can harbor bacteria and should be replaced frequently. Gentle removal of all eye makeup nightly is essential.

Check for medications that cause eye dryness: A partial list of these drugs is provided below.

     Aspartame (NUTRASWEET)

     Antihistamines (Benadryl, Coricidin)

     Atropine

     Vitamin A analogs (isotretinoin)

     Chlorothiazide (diuretics)

     Codeine

     Decongestants (Sudafed)

     Decongestant eye drops (Visine, Murine, Prefrin, Clear Eyes)

     Diazepam, valium, lithium (anti-anxiety agents)

     Hashish (marijuana)

     Methotrexate and other cancer drugs

     Morphine

     Practolol

     Scopolamine

     Tranquilizers (Elavil, Valium)

     Beta blockers: Timolol, Timoptic, Betoptic, Betagan, Ocupress (glaucoma eye drops)

Check on your soft contact lenses: Soft lenses may promote the evaporation of tears from the surface of the eyes. In severe dry eye cases, contact lenses cannot be worn. However, there are new materials in contact lenses that maintain moisture in the lens longer, so that even marginal dry eyes can be comfortable. Check with your eyecare professional for an evaluation to see if these new lenses can meet your vision needs.

Essential oils are needed in the diet in order to provide lubrication for the joints, the eyes, and to restore normal lubrication to the body. There are good fats and bad fats. The undesired saturated fats are found in meats, fried foods, butter, diary products, and margarine. The good fats are called polyunsaturated fats, especially Omega-6 (non-hydrogenated) and Omega-3 fats found in cold-water fish and flax seeds and walnuts. It is important to maintain the proper balance between the various Omega fatty acids. (see another article in this section on “Fatty Acids- The Good, Bad and Ugly”)

NUTRITIONAL SUPPLEMENTS- the best formula I have seen is called BioTears and is manufactured by Biosyntrx (www.biosyntrx.com). This formula contains all the necessary nutrients to treat dry eye conditions and usually works within 30 days. It is available through eyecare professionals or on their web site.