Eyes, Ears, Nose & Throat

Halt Age-Related Macular Degeneration

AMD affects approximately 25 percent of people older than 74 years, and its prevalence is increasing.

By UHN Staff • December 8, 2016

Age-related macular degeneration (AMD) is the leading cause of blindness in the developed world. It affects approximately 25 percent of people older than 74 years and its prevalence is increasing.

AMD is characterized by damage to the macula, a small spot near the center of the retina. This part of the eye is needed for sharp, central vision, which lets you see straight ahead.

Symptoms of Age-Related Macular Degeneration

Age-related macular degeneration patients typically report fluctuations in symptoms (days when vision is poor and other days when it appears improved). AMD symptoms include:

• A dark or empty spot in your central vision.
• Straight lines appearing wavy or fractured.
• Difficulty with reading.
• Difficulty making out faces.
• Difficulty distinguishing colors.
• Difficulty with night vision and with changing light conditions.

Because people with early and intermediate AMD are usually symptom-free, detecting it requires a visit to an ophthalmologist for a comprehensive dilated eye exam. There are also tests you can do at home to alert you to vision changes that may indicate developing or worsening AMD. Two examples:

• The Amsler Grid. Similar to graph paper, with dark lines forming a square grid, this test is used to spot wavy, broken, or distorted lines or a blurred or missing area of vision, both of which are early signs of AMD.
• The Face Test. Every morning, cover one eye with your hand and look at your face in the mirror. Then switch hands. If you notice any central blurring or missing parts, contact your doctor.

Age-Related Macular Degeneration Causes and Risk Factors

AMD is caused by the interplay between genes and environmental factors that lead to excessive inflammation and oxidative stress within the eye.

Aging, cigarette smoking, and family history are all strongly associated with the disease, whereas obesity, history of cardiovascular disease, and hypertension are moderately associated with AMD risk.[1-3] Poor diet is a significant risk factor.[3]

Conventional Treatments

There are no current treatments, natural or conventional, to reverse the vision loss that occurs in dry AMD. Most conventionally trained doctors recommend a specific combination of antioxidant nutrients in supplement form, commonly known as the AREDS formula, to halt progression of the disease. (See more under the “Natural Treatment” section below.)

Neovascular AMD—a less common but more severe form of AMD—is treated by injecting the eye with anti-vascular endothelial growth factor (anti-VEGF) agents. These drugs can reduce and prevent formation of the abnormal blood vessels and fluid leakage that characterize wet AMD. Possible complications are retinal detachment and the development of a cataract. Adverse effects are rare but include endophthalmitis, which can leads to loss of vision or severe eye damage.

Top Natural Treatments for AMD

Natural treatments can significantly stall and/or prevent AMD progression.

Diet. Western-style diets greatly increase AMD risk, while diets characterized by higher intake of vegetables, legumes, fruit, whole grains, fish and seafood, and nuts are associated with a much lower risk.[4,5]

In July 2016, ScienceDaily.com reported, “Researchers boosted the potency of a broccoli-related compound by 10 times and identified it as a possible treatment for age-related macular degeneration, the leading cause of vision loss affecting more than 10 million older Americans.”

To postpone or prevent the effects of AMD, increase these foods, which are consistently shown to lower the risk of AMD:

• Fruits (especially anthocyanin-rich berries; see below)[2]
• Vegetables, including broccoli and (see below) those rich in lutein/zeaxanthin [6]
• Fish (especially oily fish such as herring, salmon, and sardines, which provide the omega-3 fatty acids EPA and DHA) [3]
• Nuts [7]

Decrease these foods, which are most consistently shown to increase AMD risk:

• Red meat [2,8]
• High glycemic index carbohydrates (foods made with added sugars and refined grains, white potatoes, white rice, etc.).[9-11]

Lutein and zeaxanthin. People with AMD have lower levels of lutein and zeaxanthin in their retinas.[12] These two compounds are xanthophylls, a category of carotenoids. Getting more lutein and zeaxanthin through your diet is associated with a lower risk of AMD.[13] Studies point to lutein and zeaxanthin as the most influential nutrients on AMD.[14]

The best food sources of lutein and zeaxanthin are leafy greens, especially kale, spinach, Swiss chard, collards, turnip greens, and mustard greens. Cooking these greens and eating them along with a fat like olive oil provides the highest levels of bioavailable xanthophylls.

Green peas, summer squash, and egg yolks are also good sources. Aim for eating a large serving of at least one of these foods as often as possible, preferably daily.

If you currently have AMD, you might consider—in addition to eating lutein-zeaxanthin-rich foods—taking lutein and zeaxanthin supplements to ensure consistently therapeutic levels of these carotenoids.

• Lutein: 10 to 20 mg/day
• Zeaxanthin: 2 mg/day

Anthocyanins. Anthocyanins are known to penetrate the cells of the nervous system, including those of the retina, where they have antioxidant, anti-inflammatory, and other protective/healing properties. Much preliminary research suggests eating anthocyanin-rich foods or taking anthocyanins in supplement form helps prevent and/or treat numerous eye diseases, including AMD. For example, berry anthocyanidins have been shown to help protect the human retina from aging and light-induced damage.[15,16]

Berries and other purple-colored plant foods are rich sources of anthocyanins. Blueberries are particularly concentrated in anthocyanins, as are other dark berries, purple grapes, purple cabbage, purple carrots, purple potatoes, and purple radishes. Aim for eating berries and/or one of these foods as many days of the week as possible.

Dietary supplements. In people who already have AMD, supplements may help prevent progression of the disease. The evidence primarily comes from the two large Age-Related Eye Disease Study (AREDS) trials. An over-the-counter supplement, PreserVision AREDS Formula by Bausch & Lomb, was developed based on the results of these studies.

The original AREDS study evaluated high-dose antioxidant vitamins C (500 mg) and E (400 IU), beta-carotene (15 mg), zinc (zinc oxide, 80 mg), and copper (cupric oxide, 2 mg).[18] The supplement resulted in a 25 percent reduction in the progression to from intermediate to late AMD and the effect persisted for five years after the trial ended.

The second study found that the addition of lutein (10 mg) and zeaxanthin (2 mg) further reduced the risk of progression to late AMD.[20]

Additional supplements. Other studies have found that formulas containing ingredients similar to those in the AREDS formulas, as well as other vitamins and natural ingredients, are also beneficial.

• Vitamins B12, B6, and folic acid. In one recent study, people who reported taking a vitamin B12 supplement had a 47 percent reduced risk of AMD.[22] Supplementation with vitamin B12 (1 mg), folic acid (2.5 mg), and vitamin B6 (50 mg) has been found to significantly reduce the risk of AMD in adults with cardiovascular risk factors.[23]
• Selenium. There are published anecdotal reports of selenium supplementation benefiting patients with AMD, and although no clinical trials have been published yet, most integrative and natural practitioners recommend selenium supplementation (200–400 mcg) for AMD treatment and prevention.

Summary of suggested supplements:

• Vitamin C: 500 to 1000 mg/day
• Vitamin E (as natural mixed tocopherols): 400 IU/day
• Selenium: 200 to 400 mcg/day
• Zinc: 80 mg/day
• Copper: 2 mg/day
• Folic acid: 2.5 mg/day (2500 mcg/day)
• Vitamin B6: 50 mg/day
• Vitamin B12: 1 mg/day (1000 mcg/day)

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Originally published in February 2016 and updated.