Blindness is not inevitable for people who have Age-Related Macular Degeneration (AMD or ARMD), otherwise known as Macular Degeneration (MD). The same is true for people whom age isn’t the basis for Macular Degeneration, as we are seeing sharp increases in MD among people in their 40’s. The only distinction between the three acronyms is one can be age-related as well, but they are all considered Macular Degeneration.
What you eat, your lifestyle and other aspect influence whether you’ll get MD. Luckily, there are several key factors that can help prevent, and even reverse Macular Degeneration.
There is a large amount of peer review research showing ARMD to be a nutritional and lifestyle responsive eye disease, meaning that you can stabilize and possibly even improve your vision with healthy lifestyle choices.
Most people with ARMD have dry macular degeneration. In dry macular degeneration tiny, yellow drusens develop.
Drusens are accumulations of fatty, yellow material that form in the macula and people with ARMD have more and larger drusens than what is common with aging.
They are thought to be comprised of waste proteins and lipids (oily material) that begin to accumulate due to poor circulation and waste-flushing in the eye.
Antioxidants are important for the normal waste-clearing process. The drusen slowly crowd, distort, or break the cells in the macula leading to deterioration and resulting in blurred vision.
Because drusen also include immune-system regulating molecules, it is thought that they are part of the immune system.3
The second type of macular degeneration is the “wet” form, (also known as choroidal neovascularization) in which new blood vessels begin to develop near the macula, causing fast and serious vision loss. Wet macular degeneration can result from progression of dry macular degeneration, left untreated, and affects about 10% of macular degeneration patients.
If AMD is found first in one eye, the other eye follows the same progression. This is because the nutrient deficiencies and other system-wide problems would exist in both eyes but manifest in one eye before the other.
Pathology of Macular Degeneration
The development and progression of macular degeneration rest upon the occurrence of the following pathological changes in the eye.
- Oxidative stress – the imbalance between free radicals and protective antioxidants. The retina is especially vulnerable to stress from free radicals. Inability of the retina tissue to have enough oxygen available leads to deterioration of the pigmented layer which protects the retina from UV and blue light damage.5
- Angiogenesis – lack of oxygen leads to development of new extra blood vessels which distort the retina.5
- Apoptosis – cell death is a natural phenomenon in the body as the worn and damaged tissue is removed and replaced. However in the retina excessive cell death is closely tied to oxidative stress.5
- Inflammation – the inflammatory response is the body’s attempt to rescue tissue from cell injury. Proteins which are responsible for the immune results are among the constituents of drusen deposits in the retina as AMD develops.5
- Lines look distorted or wavy.
- Shapes look blurred, fuzzy, or hazy in central vision
- Colors appear dimmer and less distinct
- Words are hard to read because they are blurred
- Blank or dark areas hide the center area of your vision
- The center of vision looks foggy or cloudy
- Hypertension. People with high blood pressure are more likely to develop AMD than those with normal blood pressure.
- Diabetics are more at risk for AMD than others.
- Systemic inflammation, indicated by high levels of c-reactive protein has been tied to increased macular degeneration risk.2
It’s interesting to note that AMD incidence and blood pressure lowering medications, including vasodilators, researchers from the University of Wisconsin School of Medicine and Public Health conducted a long-term population-based cohort study from 1988 to 2013 of nearly 5,000 residents of Beaver Dam, Wisconsin, aged 43 to 86 years.
The research is part of the National Eye Institute — funded Beaver Dam Eye Study, found that using any vasodilator blood pressure lowering medications, which open (dilate) the blood vessels — was associated with a greater risk of developing early-stage AMD.3
Among people who were not taking vasodilators, an estimated 8.2 percent developed signs of early AMD. In comparison, among those who were taking a vasodilator medication, 19.1 percent developed the disease.
The researchers also found that taking oral beta blockers such as Toprol, Tenormin, and Lopressor was associated with an increase in the risk of neovascular AMD, a more advanced and vision-threatening form of the disease.
Among those who were not taking oral beta blockers an estimated 0.5 percent developed signs of neovascular AMD. In comparison among those taking oral beta blockers, 1.2 percent developed neovascular AMD.4, 5
- Free radicals can damage the eyes. They are formed when the blue and ultraviolet sunlight passes through the crystalline lens of the eye. Free radicals also result as natural metabolism byproducts. These chemical are highly reactive and cause oxidation. The result is destabilization of healthy macula cells in the eyes.
- High Homocysteine levels Studies have shown increased plasma homocysteine in patients with age-related macular degeneration.6, 7
Lifestyle and Diet
- Smoking, chronic fatigue, and a weak immune system hasten damage from free radicals. Smoking increases the risk of AMD by 200-300%. In addition, there is a link between Alzheimer’s disease and macular degeneration which is worsened by smoking.
- Poor digestion and nutritional deficiencies – People with ARMD are often deficient in a number of nutrients that are essential to eye health such as lutein, essential fatty acids, zeaxanthin, taurine, antioxidants, zinc, bioflavonoids, selenium, and vitamin B-complex.
- Low carotenoid levels. Read more about how carotenoids protect your vision.
- Heredity is a risk factor. People who have a family history of AMD are more at risk to develop the condition.
- Women are more at risk of developing AMD.
- Men who are obese have a higher risk than other men. This is associated with Western diets which are relatively high in fat and which contribute to a weak microbiota community in the digestive system. In addition to poor digestion not absorbing nutrients, this means higher levels of long-term, low-grade inflammation in the body which contributes to greater risk of macular degeneration.4
Drugs that can damage the retina
- Plaquenil (hydroxychloroquine sulfate), often prescribed for rheumatoid arthritis, has been found to cause permanent damage to the retinal.
- Chloridine (Catapres), for high blood pressure
- NSAIDS (non-steroidal, anti-inflammatory drugs) side effects from regular use include retinal hemorrhages. This group includes ibuprofen, aspirin1, ibuprofen, ketoprofen, flurbiprofen, and naproxen sodium. In addition, acetaminophen (Tylenol), though not an NSAID, can harm vision.
- Other drugs. Both prescription and non-prescription can damage the macula. Some drugs that make the eyes more sensitive to light are also harmful. Click this link to find drugs that damage the macula.
About the Macula
The macula contains two areas of unusually high concentrations of cones, which are the photoreceptors responsible for color vision, fine detail, and central vision.
There is a slightly depressed area in the center of the macula called the fovea where there are no retinal cells – only photoreceptors – about 199 to 300 thousand cones per square millimeter. At the center of the fovea is the foveola where there are only cones – no rods.
The gradual breakdown of these cells in the macula results in damage to or loss of your central vision. The macula provides focus in the center of vision where your vision sharpness is most acute. Such deterioration reduces the ability to read and recognize faces, two important tasks that use the central vision.
What you can do to protect your eyes
- Stop smoking. This is one of the most important things you can do to prevent damage to your vision. A 2005 review of research pointed out that 13 separate studies found that there was a statistically significant tie between the habit of smoking and the development of macular degeneration. The risk in smokers was two to three times higher than in non-smokers.6 A 2015 study identified damage and inflammation caused by smoking to several layers of the macula: the pigmented layer, Bruch’s membrane, the choroidal stroma.7 Additional studies in 2016 verify this finding.
- Protect against blue light. Wear sunglasses (wear wraparound sunglasses especially if you have been diagnosed with AMD) that are UV resistant to protect your eyes against damage from blue light. Another great way to reduce blue light, especially for those who look at computer monitors daily. These emit high levels of blue light. There is a great tool that can dramatically reduce blue light for those using Windows can download f.lux. f.lux for iPhones or other iOS devices, fl.lux runs on jailbroken iOS devices or on iOS9 with a sideload. For more info, visit their iOS page at justgetflux.com.
- Leafy greens. Make sure your diet includes plenty of fresh, preferably organic, dark leafy greens. These vegetables are rich in carotenoids, the colored pigments that your eye needs, especially lutein and zeaxanthin. Even if you don’t like vegetables such as collards, kale, and spinach, you can add them to soups, puree them in green drinks, juice them with other fruits and vegetables, or add them to other greens in salads. Many studies report that the nutrients found in these healthy vegetables lower the risk of developing macular degeneration.
- Low-fat diet. The Western diet, high in fats, is associated with a higher risk of macular degeneration. Researchers have found that a high-fat diet gives rise to weak gut microbiota resulting in poor digestion and long-range, low-grade inflammation in the entire body. These factors appear to be the source of high rates of AMD in men who are overweight.13
- AREDS2. The nutrients tested in 2006 (which added omega-3 fatty acids, lutein and zeaxanthin to, and reduced zinc and beta-carotene in the AREDS formula), were found to further reduce the risk of advanced AMD. As a result of AREDS2, the formula was revised to 500mg vitamin C; 400 IU vitamin E, 10mg lutein, 2mg zeaxanthin, 350mg DHA, 650mg EPA, 25mg zinc and no beta-carotene. You can find our choice of AREDS2 here as it doesn’t contain any artificial coloring chemicals added to the formulation.
- Zinc. A note for vegetarians: The AREDs studies found that zinc is necessary for a healthy macula: 11mg daily for men and 8mg daily for women. Zinc is abundant in meat and seafood. It is also abundant in nuts, grains, and legumes, but not in a readily absorbable form. The body does not store zinc well, so zinc supplementation might be needed for vegetarians and vegans.14
- Astaxanthin. Considered the “King of Carotenoids” astaxanthin is one of the highest antioxidants in the world with numerous studies that show how effective it is in combating oxidative stress. Astaxanthin is 6,000 times stronger than vitamin C; 500 times stronger than vitamin E; 3,000 times stronger than resveratrol and quercetin.10
- Omega 3 fatty acids. Many research studies have established that omega 3 fatty acids lower the risk of macular degeneration.18 Omega 3s have the ability to regulate the formation of extraneous blood vessels that distort vision.19 Eating fish is a great way to increase omega 3 in your diet.
- Omega 6 to Omega 3 Ratio. The standard western diet tends to be very high in omega 6 fatty acids, with a ratio of about 10-20:1. The Mediterranean diet has a higher proportion of omega-3; the ratio is about 4-5:1. This ratio is associated with a protective effect against the severe neovascular form of ARMD.20
- Resveratrol has been found to inhibit the growth of new blood vessels in the advanced form of macular degeneration, choroidal neovascularization.16, 17
- Vitamin D3. Low levels of vitamin D3 in the body are associated with increases in macular degeneration symptoms. D3 has anti-inflammation and anti-angiogenic capacities and has the greatest benefit in patients where the genetic risk is greatest.18 Because D3 has an important role in the immune system and aging process it is important in age-related conditions such as macular degeneration where the retina suffers age-related damage.19, 20, 21
- Melatonin. A study indicates that melatonin supplements may slow and even reverse the effects of age-related macular degeneration (ARMD). The research study included subjects with both wet and dry ARMD, and the results were the same: taking a supplement that included 3 mg of melatonin per day in the evening resulted in the stability of age-related macular degeneration after 2 or 3 months in most patients. Nearly all the subjects who stayed in the study for 6-12 months had significant reductions of ARMD and increases in visual acuity.22
- Exercise. Exercise is critical for your vision health. A study of about 4,000 older adults over 15 years found that those who were active and exercised three or more times a week were less likely to develop exudative (wet) AMD. Several studies over the last 10 years have found connections between regular exercise and reducing risks for several common eye ailments such as cataracts, wet age-related macular degeneration, and glaucoma.23
- One diagnostic tool is the Amsler Test.
- Doctors now acknowledge that at least the AREDs formulations can be helpful as macular degeneration supplements.
- Sometimes laser surgery is the recommended treatment, but it may not completely repair a leaking blood vessel without permanently damaging nerve fibers passing through the retina. The National Eye Institute reports that macular degeneration treatment using laser technology can make vision worse, and benefits towards slowing progress of the condition not appear until at more than a year following surgery.
- Photodynamic Therapy (PVT) is a generally less damaging procedure to seal blood vessels in the eye than traditional laser treatments.
- Antiangiogenesis drugs such as Macugen can be injected into the retina for wet macular degeneration; they help prevent the body from growing new, leak-prone blood vessels in the retina. Lucentis and Avastin are considered more effective injection treatment strategies. Research suggests that the best results are using a combination of Lucentis and PVT to help stabilize wet macular degeneration.
- In the future bone marrow stem cell injections or optogenetics may be used to treat conditions like AMD.
- Drugs can have potentially serious side effects, so the benefits of going on these therapies have to be evaluated with your eye doctor and family.
The best cure is prevention. You can use complementary medicine to address underlying causes of AMD, along with conventional medicine to alleviate acute event damage. Since less than 1% of those with ARMD are legally blind, most people are able to benefit greatly from prevention.
About AREDs Formulations
Most formulas commonly marketed for macular conditions are based on the 2001 AREDS studies and include vitamins C and E, zinc and beta-carotene. The AREDs formula is extremely helpful, but there are other well researched essential nutrients that need to be included to keep your macula healthy. These include lutein, zeaxanthin, meso-zeaxanthin, bilberry, essential fatty acids and other nutrients. Some of these nutrients were additionally studied in 2006 AREDS2.
2. AREDS2, Major nationwide study, by National Institutes of Health, National Eye Institute, 2006.
3. Research News: Blood Pressure Drugs and AMD, May 2014
4. Ties between Intermediate Age-Related Macular Degeneration, Lutein, and Zeaxanthin, University of WI, Departments of Opthalmology and Visual Science, et al, Archives of Ophthalmology, 2006.
5. Massachusetts Eye and Ear/Schepens Eye Research Institute, et al, Cytochrome P450-generated metabolites derived from omega-3 fatty acids attenuate neovascularization, Ryoji Yanai, et al, Proceedings of the National Academy of Sciences, June 2014.
6. J. Thornton, et al, Smoking and age-related macular degeneration: a review of association, Eye, September 2005.
7. T.D. Keenan, et al, Assessment of Proteins Associated With Complement Activation and Inflammation in Maculae of Human Donors Homozygous Risk at Chromosome 1 CFH-to-F13B, Investigative Opthalmology and Visual Science, July 2015
8. J.P. San Giovanni, et al, American Journal of Clinical Nutrition, 2009
9. Massachusetts Eye/Ear, Schepens, Harvard Medical, et al, Cytochrome P450-generated metabolites derived from omega-3 fatty acids attenuate neovascularization, Ryoji Yanai, et al, Proceedings of the National Academy of Sciences, June 2014
10. T. Otsuka, et al, Protective effects of a dietary carotenoid, astaxanthin, against light-induced retinal damage, Journal of Pharmaceutical Science, October, 2013.
11. Association between Vitamin D status and Age-Related Macular Degeneration by Genetic Risk, 2015
12. V. Lee, et al, Vitamin D rejuvenates aging eyes by reducing inflammation, clearing amyloid beta and improving visual function, Neurobiology of Aging, October, 2012.
13. E.M. Andriessen, A.M. Wilson, et al, Gut microbiota influences pathological angiogenesis in obesity-driven choroidal neovascularization, EMBO Molecular Medicine, December, 2016.
14. A. Carneiro and J.P. Andrade, Nutritional and Lifestyle Interventions for Age-Related Macular Degeneration: A Review, Oxidative Medicine and Cellular Longevity, January, 2017.
15. T.C. Mance, D. Kovacevic, et al, The role of omega-6 to omega-3 ratio in development and progression of age-related macular degeneration, Collegium, Antropologicum, September, 2011.
16. Resveratrol Inhibits Hypoxia-Induced Vascular Endothelial Growth Factor Expression and Pathological Neovascularization.
17. SIRT1 mediated inhibition of VEGF/VEGFR2 signaling by Resveratrol and its relevance to choroidal neovascularization.
18. Gerald Liew, PhD, et al, The Association of Aspirin Use With Age-Related Macular Degeneration; JAMA Internal Medicine, February, 2013.
19. Vinod P. Mitta, MD, MPH; et al, C-Reactive Protein and the Incidence of Macular Degeneration, JAMA Ophthalmology, 2013.
20. Hageman GS, et al, An integrated hypothesis that considers drusen … macular degeneration, Progressive Retina Eye Res., November, 2001.
21. E.M. Andriessen, A.M. Wilson, et al, Gut microbiota influences pathological angiogenesis in obesity-driven choroidal neovascularization, EMBO Molecular Medicine, December, 2016.
22. M. D. Pinazo-Duran, F. Gomez-Ulla, et al, Do Nutritional Supplements Have a Role in Age Macular Degeneration Prevention?, Journal of Ophthalmology, January, 2014.
23. Visual Impairment and Blindness in Adults in the United States: Demographic and Geographic Variations From 2015 to 2050.
24. Coral K, Raman R, et al, Plasma homocysteine and total thiol content in patients with exudative age-related macular degeneration age-related macular degeneration, Eye, 2006.
25. Axer-Siegel R, Bourla D, et al, Association of neovascular age-related macular degeneration and homocysteinemia. American Journal of Ophthalmology,2004.
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