Eye health: preventing macular degeneration with lifestyle changes

by Dr. Jacki Hart

To date, there is no definitive cure for macular degeneration, although there is a significant amount of research being conducted to find a good treatment. Generally, the condition gradually worsens, often leading to restriction in activities because of the loss of central vision that spreads outward.

Research shows that macular degeneration may be caused by a process called "oxidation," which damages the retinal cells; oxidative damage can similarly affect the lens of the eye, leading to development of cataracts. The oxidation process in the eye is initiated by sun exposure but also from tobacco smoke as well as lack of certain nutrients, such as antioxidants and carotenoids in the diet. Oxidative damage may be the same culprit in other age-related illnesses, such as heart disease and cancer.

Fortunately, there are ways to reduce risk of developing these eye disorders, including wearing sunglasses to protect against ultraviolet (UV) light and not smoking.

Other approaches involve dietary intervention, which is the main focus of this article. I would like to tell the story of a woman who has macular degeneration and has incorporated many of the appropriate lifestyle changes. As I relate her story, I will explain why the measures she has taken may be effective for preventing the development or progression of macular degeneration.

Evelyn (not her real name) is an 84-year-old woman whose only medical problem was arthritis until her diagnosis of macular degeneration almost 18 months ago. Surprisingly, Evelyn had not noticed any visual disturbances when she had her annual eye exam. One year earlier, during a similar routine exam, her tests were perfectly clear and she was sent home with a clean bill of eye health. This time, however, her ophthalmologist saw something of concern and conducted additional tests. Ultimately, Evelyn was diagnosed with macular degeneration and waited about three months to see an ophthalmologist who specializes in this retinal disorder.

But Evelyn did not just wait idly by—she followed the advice of her son-in-law and started taking dietary supplements that included the following ingredients:

• beta-carotene
• lutein
• vitamin E
• vitamin C
• citrus bioflavonoids
• bilberry extract
• selenium
• rutin
• lycopene

All of these ingredients function as antioxidants. Bilberry extract contains anthocyanins, the pigmented substances that are also found in blueberries, which research has shown to have very high antioxidant properties. In fact, there is more antioxidant activity in a half cup of blueberries than in five servings of broccoli. Anthocyanins are also present in red wine and the skin of grapes; some scientists think that it is the grapes in wine that confer protection against heart disease, not the alcohol, as was once thought. Although their antioxidant properties work in all areas of the body, studies suggest that the anthocyanins in bilberries and blueberries have a particularly strong affinity for the cells of the retina.

Lutein is a carotenoid found in high quantities in green leafy vegetables, particularly spinach, kale, and collard greens. Carotenoids are very protective against oxidative damage. Another important carotenoid is zeaxanthin, which is also found in greens.

Results of epidemiologic and animal studies show that the substances listed in Evelyns supplement regimen, together with wearing dark glasses to protect against UV rays and not smoking, may help prevent development of macular degeneration. In fact, another patient of mine has been using supplements with very similar ingredients for four years, hoping to avoid serious eye problems. She is 64 years old and no longer needs glasses for reading, after wearing them for a number of years. She was able to discontinue wearing glasses after following this regimen for one to two years, but she began to see improvement even prior to that.

Skeptics say that if you already have macular degeneration then dont bother using supplements because they will not make the current damage disappear. My feeling, though, is that there does not seem to be harm in using the antioxidants, particularly when they are ingested in the form of food. And, because the progression of macular degeneration can be somewhat devastating for a patient, it seems worthwhile to try these antioxidant nutrients in the hopes of lessening further disease progression and visual loss.

Despite using the supplements, Evelyn has experienced significant progression of the disease in her right eye. However, vision in her left eye has been stable since she was first diagnosed—and the left eye was actually the side in which the macular degeneration was first detected by Evelyns initial ophthalmologist.

The following regimen is what I have been recommending during the last few years to patients at high risk for developing macular degeneration:

• Consistent use of dark glasses while outside to protect from UV rays.
• A half cup of organic blueberries, fresh or frozen, per day.
• One cup of spinach, kale or collard greens at least three times, but preferably five to seven times, per week.
• A poly-flavonoid tablet containing the following:
  • --citrus bioflavonoid complex, 500 mg
  • --quercetin, 200 mg (should be taken with equal amount of bromelain for improved absorption)
  • --rutin, 50 mg
  • --bilberry extract, 25 mg (25% anthocyanins)
  • --pycnogenol, 5 mg (85% pro-anthocyanin)
  • --red cabbage extract, 100 mg (75% anthocyanin)
  • --grape skin extract, 300 mg
  • A multi-carotene tablet (should be kept refrigerated) containing the following:

Evelyn says that despite the visual loss in her right eye, she tries to do everything she enjoys, although she has had to make adjustments. She takes taxis to avoid driving at night, and she continues to attend her regular bridge games. She stopped exercising in the sun and even sold her second home in Florida. She has preserved enough vision, though, to still read avidly. Evelyn seems to take these adjustments in stride and maintains perspective, in part because many of her friends have suffered from what she considers greater difficulties. I am sure that Evelyns positive attitude doesnt hurt and I believe that the supplements she is taking probably help to stabilize her disease at least in her left eye.

Remember that the measures discussed here are likely most effective as prevention; so, if you are at high risk for developing macular degeneration—i.e., have a family history, are a current or former smoker, are exposed to second-hand smoke, have had lots of sun exposure over your lifetime, or exhibit very early signs of macular degeneration in your eye exam—consider discussing this approach with your doctor.