Macular Degeneration

Also indexed as: Age-Related Macular Degeneration, Maculopathy

What you need to know

Keep your vision in good condition by taking care to prevent macular degeneration, a leading cause of blindness later in life. According to research or other evidence, the following self-care steps may be helpful:

Load up on lutein
Supply the eyes with this healthy anti-oxidant by taking 10 mg per day and eating plenty of green leafy vegetables

Seek support from a multivitamin
Protect your sight by taking a daily multivitamin containing beta-carotene, vitamin C, vitamin E, zinc, copper, manganese, selenium, and riboflavin

Block those rays
Wear glasses that block ultraviolet rays to prevent eye damage that can contribute to macular degeneration

Go for the ginkgo
Get help for early stage macular degeneration by taking 120 to 160 mg a day of a standardised Ginkgo biloba herbal extract

Say good-bye to smoking
Kick this unhealthy habit that has been linked to increased risk

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full macular degeneration article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About macular degeneration

Macular degeneration is the degeneration of the macula retinae, also called the macula lutea, an oval disc on the retina in the back of the eye.

Degeneration of the macula retinae is the leading cause of blindness in elderly Americans.¹

Product ratings for macular degeneration

Rating	Nutritional Supplements	Herbs
	Acetyl-L-carnitine, fish oil, and co-Enzyme Q10 in combination Lutein and zeaxanthin Melatonin Multivitamin-multimineral Zinc	Ginkgo
	Beta-carotene Carotenes (prevention) (lutein, zeaxanthin, lycopene) Selenium Vitamin C Vitamin E	Bilberry Goji berry
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Macular degeneration is typically painless and includes symptoms of dark or blurry areas in the centre of vision, seeing distortions of straight lines, and difficulty doing activities that require sharp vision (e.g., driving and reading). Peripheral (side) vision may remain clear.

Dietary changes that may be helpful

In a preliminary study, high intake of saturated fat and cholesterol was associated with an increased risk of developing macular degeneration.²

According to preliminary research, people who eat fish more than once per week have half the risk of developing age-related macular degeneration compared with people who eat fish less than once per month.³

Total alcohol consumption has not been linked to macular degeneration in most studies.⁴ ⁵ However, one research group has linked beer consumption to macular degeneration,⁶ ⁷ and in one of two trials, wine drinkers were found to have a significantly lower risk of macular degeneration compared with people not drinking wine.⁸ ⁹ Most doctors consider these reports too preliminary to suggest either avoiding beer or increasing wine consumption.

Lifestyle changes that may be helpful

Smoking has been linked to macular degeneration. Giving up smoking may reduce the risk of developing macular degeneration.

Other therapies

Eyeglasses are often prescribed that provide protection from the sun’s ultraviolet rays. Underlying medical conditions, such as diabetes and high blood pressure, are treated when present. In some cases, laser eye surgery may be recommended.

Vitamins that may be helpful

Lutein and zeaxanthin are anti-oxidants in the carotenoid family. These carotenoids, found in high concentrations in spinach, collard greens, and kale, have an affinity for the part of the retina where macular degeneration occurs. Once there, they protect the retina from damage caused by sunlight.¹⁰

Harvard researchers reported that people eating the most lutein and zeaxanthin—an average of 5.8 mg per day—had a 57% decreased risk of macular degeneration, compared with people eating the least.¹¹ While spinach and kale eaters have a lower risk of macular degeneration, blood levels of lutein did not correlate with risk of macular degeneration in one trial.¹² ¹³ In a double-blind study of people with macular degeneration, supplementation with lutein (10 mg per day) for one year significantly improved vision, compared with a placebo.¹⁴ Lutein was beneficial for people with both early and advanced stages of the disease. Lutein and zeaxanthin can be taken as supplements; 6 mg per day of lutein may be a useful amount.

Sunlight triggers oxidative damage in the eye, which in turn can cause macular degeneration.¹⁵ Animals given anti-oxidants—which protect against oxidative damage—have a lower risk of this vision problem.¹⁶ People with high blood levels of anti-oxidants also have a lower risk.¹⁷ Those with the highest levels (top 20th percentile) of the anti-oxidants selenium, vitamin C, and vitamin E may have a 70% lower risk of developing macular degeneration, compared with people with the lowest levels of these nutrients (bottom 20th percentile).¹⁸ People who eat fruits and vegetables high in beta-carotene, another anti-oxidant, are also at low risk.¹⁹ Some doctors recommend anti-oxidant supplements to reduce the risk of macular degeneration; reasonable adult levels include 200 mcg of selenium, 1,000 mg of vitamin C, 400 IU of vitamin E, and 25,000 IU of natural beta-carotene per day. However, a preliminary study found no association between age-related macular degeneration and intake of anti-oxidants, either from the diet, from supplements, or from both combined.²⁰ Moreover, in a double-blind study of male cigarette smokers, supplementing with vitamin E (50 IU per day), synthetic beta-carotene (about 33,000 IU per day), or both did not reduce the incidence of age-related macular degeneration.²¹

Two important enzymes in the retina that are needed for vision require zinc. In a double-blind trial, supplementation with 45 mg of zinc per day for one to two years significantly reduced the rate of visual loss in people with macular degeneration.²² However, in another double-blind trial, supplementation with the same amount of zinc did not prevent vision loss among people with a particular type of macular degeneration (the exudative form).²³

In a preliminary trial, supplementation with melatonin (3 mg per day at bedtime for at least three months) resulted in an improvement in the abnormalities observed on eye examination in the majority of cases.²⁴ Melatonin is believed to work by regulating eye pigmentation (and, consequently, the amount of light reaching the retina) and by functioning as an anti-oxidant.

In a double-blind study, supplementation with a proprietary blend of acetyl-L-carnitine, omega-3 fatty acids from fish oil, and co-Enzyme Q10 for 12 months resulted in an improvement in both visual function and in objective findings on eye examination (a decrease in the drusen-covered area on the retina).²⁵

In a blinded six-month study of people with macular degeneration, vision was the same or better in 88% people who took a nutritional supplement, compared with 59% of those who refused to take the supplement (a statistically significant difference). The supplement used in this study contained beta-carotene, vitamin C, vitamin E, zinc, copper, manganese, selenium, and riboflavin.²⁶ People wishing to take all of these nutrients may supplement with a multivitamin-multimineral formula.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Ginkgo(Ginkgo biloba) may help treat early-stage macular degeneration, according to small, preliminary clinical trials.²⁷ Many healthcare professionals recommend 120 to 240 mg of standardised extract (24% ginkgo flavone glycosides and 6% terpene lactones) in capsules or tablets per day.

Goji berries are also a rich source of zeaxanthin, a carotenoid that when consumed becomes concentrated in the macular pigment of the eye and may help protect the retina.²⁸ ²⁹ Both human and monkey studies have shown that consuming goji berries or extracts high in zeaxanthin raises blood levels of zeaxanthin,³⁰ ³¹ ³² ³³ but only animal research has verified that goji berry consumption increases macular pigment, and no research has looked at whether goji berries provide protection from diseases of the retina.

Bilberry’s active flavonoid compounds, anthocyanosides, act as anti-oxidants in the retina of the eye. Therefore, supplementing with bilberry would theoretically be of value for the prevention or treatment of early-stage macular degeneration.³⁴ Bilberry has also been shown to strengthen capillaries and to reduce bleeding in the retina.³⁵ A typical amount of bilberry used in studies was 480–600 mg per day of an extract standardised to contain 25% anthocyanosides, taken in capsules or tablets.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References

1. National Advisory Eye Council. Report of the Retinal and Choroidal Diseases Panel: Vision Research CA National Plan: 1983–1987. Bethesda, MD: US Dept of Health and Human Services, 1984. National Institutes of Health publication 83–2471.

2. Mares-Perlman JA, Brady WE, Klein R, et al. Dietary fat and age-related maculopathy. Arch Ophthalmol 1995;113:743–8.

3. Smith W, Mitchell P, Leeder SR. Dietary fat and fish intake and age-related maculopathy. Arch Ophthalmol 2000;118:401–4.

4. Smith W, Mitchell P. Alcohol intake and age-related maculopathy. Am J Ophthalmol 1996;122:743–5.

5. Ajani UA, Christen WG, Manson JE, et al. A prospective study of alcohol consumption and the risk of age-related macular degeneration. Ann Epidemiol 1999;9:172–7.

6. Moss SE, Klein R, Klein BE, et al. Alcohol consumption and the 5-year incidence of age-related maculopathy: the Beaver Dam eye study. Ophthalmology 1998;105:789–94.

7. Ritter LL, Klein R, Klein BE, et al. Alcohol use and age-related maculopathy in the Beaver Dam Eye Study. Am J Ophthalmol 1995;120:190–6.

8. Obisesan TO, Hirsch R, Kosoko O, et al. Moderate wine consumption is associated with decreased odds of developing age-related macular degeneration in NHANES-1. J Am Geriatr Soc 1998;46:1–7.

9. Ritter LL, Klein R, Klein BE, et al. Alcohol use and age-related maculopathy in the Beaver Dam Eye Study. Am J Ophthalmol 1995;120:190–6.

10. Bone RA. Landrum JT. Distribution of macular pigment components, zeaxanthin and lutein, in human retina. Methods Enzymol 1992:213:360–6.

11. Seddon JM, Ajani UA, Sperduto RD, et al. Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. JAMA 1994:272:1413–20.

12. Blumenkranz MS, Russell SR, Robey MG, et al. Risk factors in age-related maculopathy complicated by choroidal neovascularization. Ophthalmology 1986:93:552–8.

13. Mares-Perlman JA, Brady WE, Kleain R, et al. Serum antioxidants and age-related macular degeneration in a population-based case-control study. Arch Ophthalmol 1995;113:1518–23.

14. Richer S, Stiles W, Statkute L, et al. Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial). Optometry 2004;75:216–30.

15. Young RW. Solar radiation and age-related macular degeneration. Surv Ophthalmol 1988:32:252–69.

16. Katz ML, Parker KR, Handelman GJ, et al. Effects of antioxidant nutrient deficiency on the retina and retinal pigment epithelium of albino rats: a light and electron microscopic study. Exp Eye Res 1982;34:339–69.

17. West S, Vitale S, Hallfrisch J, et al. Are anti-oxidants or supplements protective of age-related macular degeneration? Arch Ophthalmol 1994:112:222–7.

18. Eye Disease Case-Control Study Group. Antioxidant status and neovascular age-related macular degeneration. Arch Ophthalmol 1993:111:104–9.

19. Goldberg J, Flowerdew G, Smith E, et al. Factors associated with age-related macular degeneration. Am J Epidemiol 1988:128:700–10.

20. Smith W, Mitchell P, Webb K, Leeder SR. Dietary antioxidants and age-related maculopathy: the Blue Mountains Eye Study. Ophthalmology 1999;106:761–7.

21. Teikari JM, Laatikainen L, Virtamo J, et al. Six-year supplementation with alpha-tocopherol and beta-carotene and age-related maculopathy. Acta Ophthalmol Scand 1998;76:224–9.

22. Newsome DA, Swartz M, Leone NC, et al. Oral zinc in macular degeneration. Arch Ophthalmol 1988:106:192–8.

23. Stur M, Tihl M, Reitner A, Meisinger V. Oral zinc and the second eye in age-related macular degeneration. Invest Ophtholmol 1966;37:1225–35.

24. Yi C, Pan X, Yan H, et al. Effects of melatonin in age-related macular degeneration. Ann N Y Acad Sci 2005;1057:384–92.

25. Feher J, Kovacs B, Kovacs I, et al. Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10. Ophthalmologica 2005;219:154–66.

26. Olson RJ. Supplemental dietary anoxidant vitamins and minerals in patients with macular degeneration. J Am Coll Nutr 1991;10:550.

27. Lebuisson DA, Leroy L, Reigal G. Treatment of senile macular degeneration with Ginkgo biloba extract: a preliminary double-blind study versus placebo. In Rokan (Ginkgo biloba): Recent Results in Pharmacology and Clinic, Fünfgeld FW, ed. Berlin: Springer-Verlag, 1988, 231–6.

28. Peng Y, Ma C, Li Y, et al. Quantification of zeaxanthin dipalmitate and total carotenoids in lycium fruits (Fructus Lycii). Plant Foods Hum Nutr 2005;60:161–4.

29. Zhou L, Leung I, Tso MO, Lam KW. The identification of dipalmityl zeaxanthin as the major carotenoid in Gou Qi Zi by high pressure liquid chromatography and mass spectrometry. J Ocul Pharmacol Ther 1999;15:557–65.

30. Khachik F, Beecher GR, Smith JC Jr. Lutein, lycopene, and their oxidative metabolites in chemoprevention of cancer. J Cell Biochem Suppl 1995;22:236–46.

31. Cheng CY, Chung WY, Szeto YT, Benzie IF. Fasting plasma zeaxanthin response to Fructus barbarum L. (wolfberry; Kei Tze) in a food-based human supplementation trial. Br J Nutr 2005;93:123–30.

32. Benzie IF, Chung WY, Wang J, et al. Enhanced bioavailability of zeaxanthin in a milk-based formulation of wolfberry (Gou Qi Zi; Fructus barbarum L.). Br J Nutr 2006;96:154–60.

33. Leung I, Tso M, Li W, Lam T. Absorption and tissue distribution of zeaxanthin and lutein in rhesus monkeys after taking Fructus lycii (Gou Qi Zi) extract. Invest Ophthalmol Vis Sci 2001;42:466–71.

34. Scharrer A, Ober M. Anthocyanosides in the treatment of retinopathies. Klin Monatsbl Augenheikld Beih 1981;178:386–9.

35. Mian E, Curri SB, Lietti A, Bombardelli E. Anthocyanosides and the walls of microvessels: Further aspects of the mechanism of action of their protective in syndromes due to abnormal capillary fragility. Minerva Med 1977;68:3565–81.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

2007-09-01