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Courtesy of Bausch & Lomb

Oxnard - Port Hueneme Optometry  Dr. Don Steensma 465 W. Channel Islands Blvd, Port Hueneme, CA 93041  805/486-3585

Ocular Nutrition

We have always thought that nutrition is a factor in maintaining good eye health.    As early as 400 B.C. sailors who stayed out to sea for a long were noted to develop illnesses that today we call scurvey.  Its cause is lack of vitamin C.   One manifestation of the condition is dry eyes.  Most animals can produce their own Vitamin C, but primates including us cannot.

Vitamin A is required for the chemical reactions that take place in the retinal photo-receptors that lead to vision.  Vitamin A deficiency can lead to night blindness and in severe cases total blindness.   It is rare in this country but is thought to occur in up to one third of children under 5 years of age around the world.

In the year 1999 the AREDS report demonstrated that nutritional supplements could significantly slow the progression of macular degeneration. The AREDS report was based on 4,000 subjects followed over a minimum of five years. The study participants took supplements of Beta Carotene, Zinc, Vitamin C and Vitamin E and they had 25% better outcome than those not taking the supplements. Since then these supplements have been frequently used in the management of ARMD.

In the last ten years since AREDS several studies have impacted the use of the AREDS supplements. Beta Carotene has been shown to increase the risk of lung cancer in smokers. Zinc supplements can cause genitourinary problems. Vitamins C and E are strong antioxidants and are still recommended.

Other studies now point to other supplements that might be effective. Omega-3 fatty acids are fatty acids, which have anti-inflammatory properties. Omega-6 fatty acids have the opposite effect and promote inflammation. Omega-3 is commonly found in cold-water fish (salmon, sardines and tuna) and nuts. The appropriate supplement level is thought to be 1g to 3g/day.  This powerful antioxident appears helpful in macular degeneration and dry eyes as well as cardiovascular disease.

Co-enzyme CoQ10 is associated with increased metabolic activity. Studies have shown that CoQ10 levels in the retina decrease with age so we think that increasing its level might slow the progression of the disease. Wheat germ and fish are good natural sources of CoQ10. The appropriate supplement level is thought by many to be 100 mg/day.

Trans-reveratrol is another antioxidant although not as strong as Vitamin C and E. A few studies have shown some benefit in macular health. Trans-reveratrol also lowers LDL cholesterol and may be a factor in cancer prevention. It is found in red grapes and wine. A safe supplement level may be 50mg/day.

EGCG is another antioxidant, which may play a role in macular degeneration as well as cancer prevention. It is most commonly found in green tea. One cup of green tea contains about 400mg. It is thought that only one or two cups/day is safe.

Vitamin D is a fat-soluble hormone that has been shown to be a factor in controlling bone disease, some types of cancer and tooth decay. A 2007 study of 7,000 people indicated that those with the higher blood levels of Vitamin D were less likely to show early signs of macular degeneration.

Lutein and zeaxanthin are natural plant pigments. They find their way into our body only through diet. The macular pigment cells have the highest concentration of these pigments than anywhere else in the body. Dietary sources of lutein are the green leafy vegetables like spinach. Two cups of raw spinach contain 3mg of Lutein. Zeaxananthin is found in corn, yellow peppers, goji berries and egg yolks. If dietary intake is limited, 15mg of luetin and 6mg of Zeaxanthin may be appropriate if macular disease is likely.

The AREDS 2 study began in 2008. It was published in 2013.  The AREDS2 Study was designed to determine if adding omega-3 fatty acids or lutein and zeaxanthin would make it more effective.  A secondary goal was to determine if eliminating beta-carotene from the formula would be detrimental (A different study showed a relationship between beta-carotene and lung cancer in smokers). A third goal of the study was to determine if decreasing the amount of zinc would be detrimental.  The study determined that replacing beta-carotene with lutein and zeaxanthin was neither better nor worse than the original AREDS formula O.S.

If you have macular degeneration or at risk for it I would recommend an Bausch & Lomb PreserVision ARED’s 2 Soft Gel©  supplement (500mg Omega-3, 5mg lutein, 226mg Vitamin C, 200 mg Vitamin E, 35mg of zinc and 1mg of copper, 1mg Zeaxanthin) twice a day with food.  Because of the fairly small amount of Omega-3 (500mg) I would also recommend one or two 1,000mg Omega-3 per day.  Omega-3 fatty acids are also a blood thinner, so be sure to discuss this with your physician.

There are several companies that make these supplements, but the Bausch & Lomb versions are more readily found in this area.

 

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