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
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
-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
-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
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 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.
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
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.
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,