How to Choose Vitamins for Macular Degeneration?

Studies have shown that macular degeneration is the third most important cause of blindness in the world.

This is an eye disease affecting the central area of the retina known as the macula.

The prime function of the macula is to provide us with the ability to read in great detail. At the same time, the remaining portion of the retina is concerned only with peripheral vision.

At the centre of the macula, there is a small spot called the fovea centralis, which is responsible for your colour vision and ability to identify complex images.

The light which falls on the human eye is focused on the macula where it is converted into electrical signals. These signals will be transmitted in the form of nerve impulse to the brain where a complete image of the object is formed.

As per Maria Richman, OD, spokeswoman for the American Optometric Association. “It is the small and highly sensitive part of the retina that is responsible for the detailed central vision. The macula allows one to appreciate the detail and perform tasks that require central vision, such as reading.”

The graph below shows the percentage of adults in the US aged 45 years and older who had vision loss due to macular degeneration in 2016-2017.

Source: Statista
It is estimated that in 2020, 196 million people will have macular degeneration. The number will rise to 288 million in 2040.

What are the early signs of macular degeneration?

In the early stage of the disease, lipid materials accumulate underneath the retinal epithelium.

These deposits can be seen as pale yellow spots on the retina which are commonly known as drusen.

The natural pigment of the retinal epithelium gets disturbed due to several areas of hyperpigmentation and hypopigmentation.

As the condition advances in severity, there will be a complete loss of vision in the central visual field.

In some other cases, new blood vessels tend to grow under the retinal pigment epithelium and distort vision. This could also result in haemorrhage, scarring the retinal tissue. In the later stages, there can be significant distortion.

The major risk factors for Macular Degeneration are tobacco smoking, age and genetic factors. Furthermore, the risk of getting advanced macular degeneration increases from 2% for those ages 50- 59, to nearly 30% for those over the age of 75.

It is estimated that every year 343 billion dollars is used for the treatment of macular degeneration all over the world.                                                       

Treatment of macular degeneration

1. Dry AMD (Age-related macular degeneration) treatment

If diagnosed at an early stage, ophthalmologists can view tiny deposits under the retina of the patient’s eye.

As this stage has no symptoms, treatment is usually done with multivitamins and recommended changes in diet.

A diet rich in fatty fish, vegetables, fruits and nuts is helpful in significantly reducing the vision loss.

2. AREDS2 Formula

The National Institute of Health Science (NIH) have recommended the use of the AREDS2 (Age-Related Eye Disease Study 2) formula for the treatment of early-stage diseases.

Various studies have shown that by taking supplements containing essential micronutrients, it is possible to reduce the progression of macular degeneration up to 25%.

This formula contains 

• lutein 10 milligrams (mg)
• zeaxanthin 2mg
• vitamin C 500mg
• zinc oxide 80mg or 25mg (these two doses worked equally well)
• cupric oxide 2mg
• vitamin E 400IU

Lutein and zeaxanthin and Beta carotene belong to plant micronutrients known as carotenoids. Structurally they are similar to Vitamin A, but it cannot be synthesized in the human body.

When you consume lutein and zeaxanthin, they mix up with the bloodstream and get transported to the retina to protect your eyes from light-induced damage.

Vitamins E and C are powerful antioxidants which are required by the body to produce several enzymes.

The interesting fact is that Zinc supplementation might result in Copper deficiency, as both of these micronutrients compete with each other for absorption in the intestines.

So Copper is also added as a part of the AREDS formula.

Anotherclinical trial done by Harvard researchers has shown that with a high dose of statin treatment, patients who are suffering from macular degeneration were able to improve their vision at a significant level.

3. Advanced dry AMD treatment

These patients develop atrophy of photoreceptor cells in the eye. At a more advanced stage, the areas affected will be relatively large, known as “geographic atrophy.”

At present, there is no known cure to this condition.

Some research has indicated the possibility of extracting stem cells from another part of the body such as skin and reprogramming it to become retinal cells. This is also helpful to prevent immune rejection as the DNA remains the same.

This method has been tested on some patients, but full effectiveness is yet to be determined.

4. Wet AMD treatment

This condition is known to be caused by excess growth of leaky blood vessels into the retina. By arresting or suppressing the growth of these leaky blood vessels, vision can be restored to a certain extent.

• By injecting anti-VEGF antibodies directly into the retina

The injections usually include drugs such as brolucizumab aflibercept and ranibizumab. These medications directly act on the retinal surface, allowing the retina to dry up to its normal condition.

Since this is not a cure, patients will have to repeat the treatments in 1-3 months.

• Photodynamic Therapy (PDT) 

This method is effectively known to treat a variant of wet AMD called idiopathic polypoidal choroidal vasculopathy, commonly seen in Asians. Photodynamic Therapy uses a unique combination of injections and laser therapy.

A photosensitive drug called Verteporfin will be injected into the bloodstream followed by laser treatment.

Both the laser and the injected drug will work together to seal any leaky blood vessels without inflicting harm to any other part of the eye.

• Laser Photocoagulation 

Here a concentrated laser beam will be directed to the affected part to seal off leaky blood vessels.

Do vitamins help with macular degeneration?

Research conducted by the National Eye Institute of the National Institutes of Health showed various benefits of taking supplements that have Vitamins C and E, beta-carotene, Zinc, and Copper.

Scientists believe that the risk for vision loss is significantly reduced after regular consumption of essential vitamins.

Vitamins for macular degeneration

With more and more research confirming the usefulness of using vitamin supplements to treat macular degeneration, it is highly recommended by health practitioners to supplement a regular diet with vitamins, especially if you are someone who is diagnosed with macular degeneration.

Let us take a close look at some of the important vitamins. 

1. Vitamin A

This Vitamin, along with its precursor, beta-carotene is necessary for wound healing, night vision and the proper working of the immune system.

In developed countries, Vitamin A deficiency is quite rare. However, if unaddressed, it can lead to serious conditions such as xerophthalmia.

Regularly consuming Vitamin A helps to prevent several eye afflictions.

Studies have indicated that supplementing Vitamin A and consuming an appropriate diet is a sure way to battle various eye disorders such as cataracts and age-related macular degeneration. 

2.Vitamin B complex.

Scientists have studied the various impacts of B Complex vitamins on the eye, particularly B6, B9 and B12.

B complex vitamins help to lower homocysteine, a protein which is associated with the risk of developing macular degeneration.

Studies done on women have indicated a 34% reduction in the risk of developing macular degeneration while consuming 1,000 mcg of B complex vitamins.

Riboflavin is another B vitamin which has the potential to reduce the oxidative stress in the eyes.

In a study conducted on participants who were supplemented with Riboflavin (1.6–2.2 mg /day) have indicated a 31–51% decreased risk of developing cataract.

3. Vitamin E

Vitamin E acts as a potent antioxidant to protect your sensitive eye cells from the damage caused by free radicals in the body.

Ophthalmologists believe that many eye disorders including macular degeneration are due to oxidative stress in the body.

A seven-year study conducted on 3,640 people with advanced macular degeneration has indicated that subjects who took 400 IU of vitamin E and several other nutrients (AREDS Formula) have shown a 25% reduction in the risk of progressing to advanced stages.

4. Vitamin C

This Vitamin is an essential part of the eye as it helps to generate collagen, a protein which provides a proper structure to the eyes. Vitamin C has several antioxidant properties as well, which safeguards eyes from the damage due to free radicals.

Vitamin C is also included as a part of the AREDS formula to benefit those who are suffering from AMD.

Studies have confirmed that regular intake of Vitamin C also reduces the risk of developing cataract.

5. Omega-3 Fatty Acids

This is a type of polyunsaturated fat. 

Omega-3 Fatty acids are helpful in the formation of the cell membrane of the retina. The anti-inflammatory property of this substance plays a major role in the prevention of diabetic retinopathy.

A review of 31 studies has indicated that diets which are rich in Omega-3 Fatty Acids may help to protect against diabetic retinopathy.

This is highly helpful in treating individuals with dryness of the eye and those with macular degeneration.

Are there any risks of taking these multivitamins and supplements?

While vitamin supplements for eyes are generally safe and beneficial, it is better to be careful if you are nursing or pregnant.

Always talk to your doctor before planning to take any vitamin supplements. Although there are no known serious side effects, some minor ones include 

• Headache
• Upset stomach
• Strange or unpleasant taste in the tongue

Final Words

Significant research and evidence has proven the fact that supplementing proper Vitamins along with a healthy meal prevents the progression of macular degeneration.

Macular degeneration is a serious eye condition and needs prompt care and management. Consult your ophthalmologist and start your vitamin supplements as early as possible. 

After all, the world is beautiful and there’s a lot to see (provided you have a healthy vision)!

References

Redmer van Leeuwen, Sharmila Boekhoorn, Johannes R Vingerling, Jacqueline C M Witteman, Caroline C W Klaver, Albert Hofman, Paulus T V M de Jong(28 Dec 2005) Dietary intake of antioxidants and risk of age-related macular degeneration. Available at  https://pubmed.ncbi.nlm.nih.gov/16380590/  [Accessed 24 June 2020]

William G Christen, Robert J Glynn, Emily Y Chew,Christine M Albert,Joann E Manson (23 Feb 2009) Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: the Women's Antioxidant and Folic Acid Cardiovascular Study  Available at  https://pubmed.ncbi.nlm.nih.gov/19237716/ [Accessed 28 Jul 2020]