Macular Degeneration (AMD)

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

 There are two types of AMD—the wet and the dry forms. The wet form accounts for only 10 percent of cases. It occurs when tiny new abnormal blood vessels begin to grow behind the retina toward the macula. These abnormal vessels often leak blood and fluid, which damage the macula, causing rapid and severe vision loss. The dry form constitutes the other 90 percent 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, causing distorted vision in the eye, but is less severe than the vision loss in the wet variety.

There are certain risk factors that can increase your susceptibility to AMD. These risk factors are:

-Age. It is estimated that about 14 percent of people aged fifty-five to sixty-four have some form of AMD. This rises to about 25 percent of persons aged sixty-five to seventy-five, and up to 37 percent of those over seventy-five.

-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 the poor blood circulation to the eyes.

-Diet and nutrition. The macula’s fragile cells are highly susceptible to damage from the oxygen-charged molecules called free radicals. Research shows that people with a low dietary intake of antioxidants may be at risk for developing AMD. In addition, alcohol may deplete the body of antioxidants. High levels of saturated fats and cholesterol harm blood vessels and are also involved in producing free-radical reactions.

-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 than people with dark eyes, as are individuals who are exposed to UV light for prolonged periods of time.

-Smoking. Recent studies showed that smoking, which reduces the amount of protective antioxidants in the eye, more than doubles the risk of AMD. They found that AMD is more than twice as common in people who smoke more than one pack of cigarettes a day than in people who do not smoke, and the risk remains high even up to fifteen years after quitting.

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

-Gender and race. Women over the age of seventy-five have double the chance of developing AMD as men of the same age. Low levels of estrogen in postmenopausal women may also increase the risk for the condition. There is some suggestion that postmenopausal estrogen therapy may protect against AMD, but more research is needed in this area. Women also live longer than men. Caucasians are much more likely than African-Americans to lose vision to AMD.

The symptoms of macular degeneration start with a slight blurring of your vision. This can then change into a distortion of the image that you see. Macular degeneration does not result in total blindness. Since the macular area is responsible just for central vision, only this area is affected. However, a person afflicted with macular degeneration can feel very helpless and frustrated due to the loss of detail vision. The peripheral vision usually remains intact and therefore allows the person to function almost normally. This is especially true if only one eye is affected.

At one time lasers had been used in the treatment of the wet form of macular degeneration. In this procedure, the laser was used to coagulate (clot) the tiny blood vessels that have grown near the macula.

More recent developments in the medical treatment of AMD have focused on the wet form. The first actual treatment of AMD was called Photo-Dynamic Therapy (PDT). This process used a compound called verteporfin, which is a photosensitive drug. This drug is injected into the blood stream and it travels to the blood vessels in the retina, where it is then activated by shining a low intensity laser onto the damaged area. This causes a chemical reaction that destroys the abnormal blood vessels. While it is effective in retarding the deterioration of vision, it must be repeated several times a year.

In 2004, genetic research discovered a component of DNA that was responsible for growth of blood vessels. This was named the “Vascular Endothelial Growth Factor”, or VEGF. It was also determined that this factor was responsible for the growth of the blood vessels in the macula during AMD. This has lead to research to develop medications that inhibit this blood vessel growth factor (thus the category name, “Anti-VEGF” drugs).

There are positive trends in the treatment of AMD and more medications are being developed. However, most forms of macular degeneration cannot yet be reliably treated either medically or surgically. The best way to “treat” AMD is to prevent it.

The Nutritional Approach:

The largest study of nutritional treatment for AMD was concluded in the late 1990s. This study was called the Age-Related Eye Disease Study, or AREDS. The supplement that the study participants took was a combination of beta carotene (15mg); Vitamin C (500mg); Vitamin E (400 IU); Zinc Oxide (80 mg) and Copper Oxide (2 mg). The result showed that while there was no preventive effect nor was there any reversal of AMD, there was a slowing of the progression from stage III to stage IV (the most advanced stages).

As of 2006, a follow-up study is being conducted to fine-tune these results and see what effect lutein and zeaxanthin have on AMD (called AREDS II). The AREDS formula is better than doing nothing but it is not the final product to help forestall the development of AMD. There are many more nutrients that can affect macular function which will be detailed below.

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

Anything that prevents clogging of your arteries may help to 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 if you are a man and three per week if you are a woman.

More Details:

Recent peer-reviewed studies strongly suggest that Acetyl-L-Carnitine and Lipoic Acid greatly enhance nutrient cellular delivery, while providing increased ATP energy and a sense of well being in most people. This data was confirmed in an Italian study that found a combination of Acetyl-L-Carnitine, CoQ10 and Fish Oils actually reversed some of the physical manifestations of AMD.

We are very appreciative of the ARED study and its effect on the eye care professionals' understanding of the relationship between nutrients and macular degeneration.  However, it is noted in the body of the ARED study that 57% of the study participants were already taking antioxidant vitamins before enrolling in this study, and an additional 13% who were not taking supplements chose to take a multi-vitamin mineral supplement on top of the ARED formulation.  Therefore, almost 70% of those in the trial also concurrently took an additional multiple.

We question whether concurrent taking of a broad-based multiple, which contained additional levels of the full spectrum of nutrients, including small amounts of lutein, could be the reason why the study achieved positive results. The study authors state that the treatment effect of the study formulations was in the beneficial direction for both the age-related macular degeneration patients who took and didn't take a multiple, but they state the data are not shown and that these comparisons are inadequate. Therefore, it is prudent to offer a multiple for the AMD patients that contains potent amounts of full-spectrum supplemental nutrients and antioxidants. Macula Complete is presented in capsule form to assure bioavailability for the older consumer.

Quality formulations include a more bioavailable form of zinc than the formulation used in the ARED study. Zinc monomethinine is appropriately balanced with the scientific standard ratios of both copper and manganese to stimulate manganese super-oxide dismutase (MnSOD), which is required to neutralize both singlet oxygen and super-oxide free radicals. The 80 mg of zinc used in the ARED formulation was based on a single nutrient study published more than 15 years ago.

Current science suggests that no more than 50 mg of zinc is appropriate for daily long term-consumption. The Institute of Medicines' upper limit for daily zinc supplementation is 40 mg per day. Given the opinion of a large number of PhD nutrition researchers, we believe 50 mg is the maximum amount of zinc safe for daily consumption.  We now understand that supplemental minerals are most effective when presented in properly balanced formulations.

FloraGLO® Lutein provides extra support for the macula, extra support for breast tissue and to further help prevent UV skin damage. The ARED study formulation does not include lutein. New science strongly suggests a central macula preference for zeaxanthin over lutein. A quality supplement should contain 4 mg of zeaxanthin.

The ARED study formulation also used beta carotene as the Vitamin A source.  Unfortunately, excessive amounts of beta-carotene interferes with zanthophil absorption, as in lutein and zeaxanthin.  Beta-carotene is also linked to increased rates of lung cancer in smokers who also use alcohol. Given the high rate of smokers in the AMD population, we would not feel safe including more than 3000 IUs of beta carotene in multiple formulations.

The antioxidant anthocyandins increase intracellular vitamin C levels, improve ocular microcirculation and protect the vascular endothelium, as well as inhibit collagen destruction and decrease capillary fragility. And antioxidant bioflavinoids further prevent the oxidation of LDL. Oxidized LDL plays a key role in vascular damage.  Bioflavinoids work synergistically with vitamin E to protect the purified rod outer segments (ROS) and retinal pigment epithelium (RPE) in the eye from free-radical induced membrane lipoperoxidation and damage. Bioflavinoids also support the capillaries that feed the eye and the brain.

Taurine is concentrated in the eye, and is essential for retinal function. It protects the eye against neurotoxins that include excessive levels of glutamate that may be responsible for the loss of ganglion cells and optic nerve damage seen in open angle glaucoma. Taurine can suppress renin and break the renin-angiotension feedback loop, resulting in lowered IOP. 

Lipoic acid synergistically regenerates other protective antioxidant nutrients that cross the blood/brain/eye barrier. Lipoic acid, in concert with acetyl-l-carnitine increases ATP cellular energy.

CoQ10 regenerates circulating antioxidants and to provide nutritional support for the vascular system. If you are taking a statin (eg, Lipitor, Zocor, etc), then you are likely deficient in this enzyme.

Acetyl-L-Carnitine increases ATP energy at the mitochondria level. Impressive amounts of research show that the most important factor in aging is the decay of the mitochondria - the organelles inside the cell that convert amino acids, fatty acids and sugars into energy. The effect is that our bodies operate at one-half to one-fourth the energy we had in our youth.

There have been reports that the amount of body fat a person has affects the amount of lutein and zeaxanthin in the retina. What this means is that the higher amount of body fat you have, the less is available for the retina. It seems that these nutrients are stored in fat tissue and are not available to the eye, even when needed.

Finally, most doctors recommend 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 can slow macular-degenerative changes. Several research studies on AMD are focusing on the role of a group of antioxidants called carotenoids. Two of these antioxidants, lutein and zeaxanthin, are the only pigments found in the macula. By contrast, beta-carotene is virtually absent from the eye (although its 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 present in dark green leafy vegetables such as spinach and collard greens. A study among male veterans showed that increasing the antioxidant intake can slow the progression of vision loss from dry AMD.

I most often just recommend a product called "Macula Complete" by Biosyntrx. This product has been formulated using the latest scientific data on the development and reversal of AMD. While there is no guarantee that the disease will stop or reverse, good nutrition has earned a place of honor in the disease process and can help the body fight this debilitating chronic disease. To find Macula Complete, click here.