Age-Related Macular Degeneration (ARMD)

Age-related macular degeneration (ARMD) involves the degeneration of the macula region of the eyes’ retina, manifesting as varying degrees of eyesight impairment.  ARMD is a form of atherosclerosis as the degeneration of the macula is caused by hardening of the blood vessels that supply the eyes.

Symptoms of ARMD include:

· Impaired central field of vision (early stages) progressing to impaired central and peripheral vision (latter stages).

· Blurred vision.

· Lines that would normally appear straight appear to be “wavy”.

· Total blindness (latter stages) - ARMD is the leading cause of blindness in the elderly.

Hypertension has been linked to an increased risk of ARMD.

Up to 25% of all people over the age of 65 and 33% of all people above the age of 75 are affected by various degrees of ARMD.

The following therapies may prevent/treat ARMD:

Lutein:

Rationale:

Lutein concentrates in the macula of the eye where it exerts antioxidant effects that help to prevent ARMD.  People who consume high amounts of dietary lutein have been found to have a 43% reduction in their risk of ARMD.

Recent research shows that lutein may help to reverse ARMD.

Dosage:

3 – 30 mg per day.

Ideally, supplemental lutein should be consumed with zeaxanthin (another carotenoid similar to lutein which exerts similar protective effects against ARMD).

Vitamin E:

Rationale:

Vitamin E may help to prevent and treat ARMD via several mechanisms including reducing abnormal blood clotting in the blood vessels that supply the eyes, reducing cholesterol levels and enhancing the effectiveness of other antioxidants that protect the eyes.

In a clinical study, 12½ years of vitamin E supplementation was associated with a 13% reduction in the risk of ARMD.

Another study involving patients with severe ARMD found that vitamin E supplementation halted the further progression of ARMD.

Dosage:

400 – 800 IU per day.

Vitamin C:

Rationale:

A clinical study found that persons with a high intake of vitamin C have a slightly lower risk of ARMD.

Another study on rats found that treatment with vitamin C helped to prevent sunlight from damaging the retina of the eye.  Sunlight-induced retina damage is one of the causes of ARMD.

Dosage:

1,000 – 3,000 mg per day.

Coenzyme Q10:

Rationale:

ARMD patients have been shown to have lower blood levels of coenzyme Q10 compared with normal, healthy persons, indicating that coenzyme Q10 may help to prevent ARMD.

Coenzyme Q10 exerts antioxidant effects that may “quench” the free radicals that cause ARMD.

Dosage:

50 – 100 mg per day.

Whey Protein:

Rationale:

Some researchers speculate that whey protein might help to prevent ARMD through its ability to increase the glutathione content of the retina.  Glutathione is one of the body’s natural antioxidants.

Dosage:

20 – 25 grams per day.

Vinpocetine:

Rationale:

Vinpocetine improves the use of glucose and oxygen in the retina and increases blood circulation to the retina.  It may thereby help to prevent/treat ARMD.

Dosage:

20 - 30 mg per day.

Vinpocetine is absorbed best when it is taken with food.

Lipoic Acid:

Rationale:

Lipoic acid may help to prevent ARMD via its ability to regenerate various antioxidants (including vitamin C, vitamin E and glutathione) in the macula of the eyes.

Dosage:

150 – 500 mg per day.

Shark Cartilage:

Rationale:

ARMD begins with the over-proliferation of blood vessels that leak under the central portion of the retina, causing the damage associated with ARMD.

Shark cartilage inhibits this over-proliferation of damaged blood vessels via a process known as anti-angiogenesis.

In a small, open-label study 24 weeks of treatment with shark cartilage resulted in improved or stabilized visual acuity in 80% of ARMD patients.

Dosage:

9,000 mg (9 grams) per day.

Bilberry:

Rationale:

The active constituents of bilberries (anthocyanosides) help to strengthen the blood vessels that supply the retina and help to prevent the bleeding of these blood vessels.  Bilberry’s anthocyanosides also function as antioxidants in the retina.

Dosage:

120 - 480 mg per day (using bilberry extract standardized to contain 25% of the active constituents, anthocyanosides).

Ginkgo biloba:

Rationale:

Ginkgo biloba improves blood circulation to the retina and exerts antioxidant effects in the retina.  These actions are useful for ARMD patients.

In a clinical study, six months of treatment with Ginkgo biloba resulted in significant improvement in visual acuity in ARMD patients.

Dosage:

120 – 240 mg per day.

Fish Oils:

Rationale:

People with high intake of docosahexaenoic acid (DHA – one of the omega-3 fatty acids present in fish oils) have been found to have a 30% reduction in their risk of ARMD.

A study on monkeys found that omega-3 fatty acids from fish oils are delivered to the retina of the eyes where they reduce the accumulation of a toxin named lipofuscin that contributes to ARMD.  The omega-3 fatty acids also exerted antioxidant effects in the retina, which may help to prevent ARMD.

Dosage:

10,000 mg (10 grams) per day for fish oils products containing 18% EPA and 12% DHA

Alternatives:

Cod Liver Oil contains the same omega-3 fatty acids that are present in fish oils.

Taurine:

Rationale:

In cats, taurine deficiency is known to cause degeneration of the retina, similar to ARMD.  It is not known whether or not this applies to humans.

Dosage:

500 – 6,000 mg per day.

Melatonin:

Rationale:

A laboratory study found that melatonin (which is produced naturally by the retina) exerts potent antioxidant effects in the retina, counteracting the free radicals that cause ARMD.  Supplemental melatonin may therefore help to prevent ARMD.

Dosage:

1 - 3 mg per night.

Do not consume melatonin during the daytime as it is a powerful sedative.

Selenium:

Rationale:

ARMD patients have been found to have lower than average blood selenium levels.

In a clinical trial, a combination of oral and intravenous administration of selenium (together with zinc) was found to cause significant improvement in vision in ARMD patients.

Dosage:

200 – 400 mcg per day.

Zinc:

Rationale:

A clinical study found that zinc (80 mg per day) reduced the risk of advanced ARMD by 21%.  When zinc was administered in combination with other antioxidants (vitamin C and vitamin E), the combination reduced the risk of further eyesight impairment in ARMD patients by 27%.

Another study found that zinc (40 mg per day for one to two years) retarded the loss of vision in ARMD patients.

In a clinical trial, a combination of oral and intravenous administration of zinc (together with selenium) was found to cause significant improvement in vision in ARMD patients.

Dosage:

15 – 50 mg per day.

Lifestyle Changes to Assist the Prevention/Treatment of ARMD

Sunlight:

Excessive exposure of the eyes to sunlight may increase the risk of ARMD.  Sunlight generates free radicals that damage the blood vessels that supply the macula region of the eyes.  Wearing sunglasses may be useful for the prevention of ARMD.

Smoking:

Tobacco smoking has been linked with an increased risk of ARMD.  Tobacco smoke generates free radicals that damage the eyes.

Vegetable Oils:

High consumption of vegetable oils has been linked with an increased risk of ARMD (due to the trans-fatty acids content of vegetable oils).

Margarine:

High consumption of margarine has been linked with an increased risk of ARMD (due to the trans-fatty acids content of margarine).

References

Bilberry

· Scharrer, A., et al.  Anthocyanosides in the treatment of retinopathies.  Klin Monatsbl Augenheikld Beih.  178(5):386-389, 1981.

Coenzyme Q10

· Blasi, M. A., et al.  Does coenzyme Q10 play a role in opposing oxidative stress in patients with age-related macular degeneration?  Ophthalmologica.  215(1):51-54, 2001.

Fish Oils

· Cho, E., et al.  Prospective study of dietary fat and the risk of age-related macular degeneration.  American Journal of Clinical Nutrition.  73(2):209-218, 2001.

Ginkgo biloba

· Fies, P., et al.  [Ginkgo extract in impaired vision - treatment with special extract EGb 761 of impaired vision due to dry senile macular degeneration.]  Wien Med Wochenschr.  152(15-16):423-426, 2002.

Lipoic Acid

· Sosin, Alan & Jacobs, Beth Kay.  Alpha Lipoic Acid:  Nature’s Ultimate Antioxidant.  Kensington Books, New York, USA.  1998:116.

Lutein

· Koh, H. H., et al.  Plasma and macular responses to lutein supplement in subjects with and without age-related maculopathy: a pilot study.  Exp Eye Res.  79(1):21-27, 2004.

Melatonin

· Liang, F. Q., et al.  Melatonin protects human retinal pigment epithelial (RPE) cells against oxidative stress.  Exp Eye Res.  78(6):1069-1075, 2004.

Selenium

· Wright, J. V., et al.  Improvement of vision in macular degeneration associated with intravenous zinc and selenium therapy: Two cases.  J Nutr Med.  1:133-138, 1990.

Shark Cartilage

· Turcotte, P.  Phase I dose escalation study of AE-941, an antiangiogenic agent, in age-related macular degeneration patients.  Retina Society Conference.  Hawaii, USA.  December 2, 1999.

Taurine

· Hayes, K. C.,. et al.  Retinal degeneration associated with taurine deficiency in the cat.  Science.  188(4191):949-51, 1975.

Vinpocetine

· Gerkowicz, K., et al.  Clinical trials of using Cavinton in the form of intravenous infusion in the treatment of macular degeneration.  Klin Oczna.  89(3):95-96, 1987.

Vitamin C

· Seddon, J. M., et al.  Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration.  Eye Disease Case-Control Study Group.  JAMA.  272(18):1413-1420, 1994.

Vitamin E

· Christen, W. G.  Antioxidant vitamins and age-related eye disease.  Proc Ass Am Phys.  3:16-21, 1999.

Whey Protein

· Increasing glutathione concentrations with whey protein concentrate.  Vitamin Research News.  15(1), 2001.

Zinc

· Newsome, D. A., et al.  Oral zinc in macular degeneration.  Arch Ophthalmol.  106(2):192-198, 1988.

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