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Macular Degeneration Prevention

By Chris A. Knobbe, MD

Although macular degeneration prevention is possible, you can't rely on any one foolproof method. However, a variety of options are available to help reduce your risk.

You should be especially diligent about prevention measures if you already have a diagnosis of macular degeneration (AMD), or if you are older and the disease runs in your family.

AMD is the leading cause of irreversible vision loss among elderly people, who slowly lose their central vision. In time, a person with macular degeneration may find it difficult or impossible to read, drive or recognize familiar faces.

Eleven Steps To Help Prevent Macular Degeneration

Here are guidelines to help prevent or slow the progression of AMD:

1. Don't smoke. Period.
2. Eat plenty of dark, leafy green vegetables, such as raw spinach. Just a half cup of raw spinach three times a week is good.
3. Take a multivitamin/multimineral supplement, such as Centrum Silver, unless your doctor advises otherwise.
4. If you already have AMD, ask your doctor about one of the AREDS formulations, such as Alcon I-Caps, Bausch + Lomb Ocuvite PreserVision or ScienceBased Health MacularProtect Complete.
5. Eat fish or take a fish oil supplement. I recommend taking two enteric-coated fish oil capsules every day on days you don't eat fish. Why enteric-coated? Because it's designed to help the capsule pass through your stomach unaltered until it finally breaks apart in the intestines; that way, you won't belch up that fishy taste!
6. Exercise regularly, and stay at a healthy weight.
7. Eat fruit and nuts daily.
8. Reduce refined carbohydrates (high-glycemic index foods).
9. Keep your blood pressure and cholesterol under control. Regular exercise and weight control can help manage your blood pressure and cholesterol.
10. Wear appropriate sunglasses outdoors to block UV and blue light that may cause eye damage.
11. Have regular eye exams.

Step One: Stop Smoking

Probably the number one way to prevent AMD is to stop smoking or not smoke in the first place. Consider findings from these studies:

• Smokers are up to four times more likely than non-smokers to have macular degeneration, public health experts at the University of Manchester said in a British Medical Journal report. In Great Britain, an estimated 53,900 people older than 69 have AMD attributed to smoking. Of that number, 17,900 are legally blind.
• Another study from the Massachusetts Eye and Ear Infirmary showed that current and past smokers had a 1.9- and 1.7-fold greater risk, respectively, of AMD compared with non-smokers.

Step Two: Eat Plenty of Greens To Prevent AMD

Eating plenty of dark, leafy greens may help with macular degeneration prevention.

A study published in 1994 in the Journal of the American Medical Association by researchers at the Massachusetts Eye and Ear Infirmary reported that people who consumed the most vegetables rich in carotenoids (lutein and zeaxanthin) had a 43 percent lower risk of AMD than those who ate these foods the least.

Carotenoid-rich vegetables include dark, leafy greens, especially raw spinach, kale and collard greens.

"In particular, a higher frequency of intake of spinach or collard greens was associated with a substantially lower risk for AMD," researchers said.

The authors concluded that "consumption of foods rich in certain carotenoids, in particular dark green, leafy vegetables, may decrease the risk of developing advanced or exudative ('wet') AMD, the most visually disabling form of macular degeneration among older people."

Step Three: Take Multivitamins/Multiminerals

Taking vitamins and minerals in the form of nutritional supplements from a trusted source may be a good idea for many reasons, including general eye health.

Particularly for an older person, it may be difficult to obtain all the nutrients you need from diet alone. Ask your doctor for advice about which supplements might work best for you based on your specific health needs.

Step Four: Consider an AREDS Nutritional Formula

High levels of antioxidant vitamins and zinc significantly reduced the risk of advanced macular degeneration and associated vision loss in a study investigating nutrition and AMD, supported by the National Institutes of Health/National Eye Institute (NEI).

This Age-Related Eye Disease Study (AREDS) found that people at high risk of developing advanced AMD lowered that risk by about 25 percent when they were treated with a high-dose combination of vitamin C, vitamin E, beta-carotene and zinc.

"This is an exciting discovery because, for people at high risk for developing advanced AMD, these nutrients are the first effective treatment to slow the progression of the disease," said NEI director Paul A. Sieving, MD, PhD.

People considered to be at high risk are those with intermediate AMD in one or both eyes, or those who already have advanced AMD in one eye. However, study participants with early AMD or no AMD did not appear to benefit from this antioxidant and zinc regimen.

There is still no cure for AMD, and proper nutrition will not restore vision after it has been lost, Dr. Sieving said. But the study shows that nutrients play a key role in helping to maintain vision in people at high risk for developing advanced AMD.

The AREDS nutritional formula included:

• 500 mg of vitamin C
• 400 IUs of vitamin E
• 15 mg of beta-carotene
• 80 mg of zinc as zinc oxide
• 2 mg of copper as cupric oxide

This same nutritional formula can be found in products such as Alcon I-Caps, Bausch + Lomb Ocuvite PreserVision and ScienceBased Health MacularProtect Complete. Variations of these products may contain extra supplements in the form of lutein and zeaxanthin and/or omega-3 fatty acids.

If you are a smoker, keep in mind that supplements containing beta-carotene, a vitamin A precursor, increase the risk of lung cancer among smokers.

However, supplementation with whole foods has not been shown to increase the risk of lung cancer among smokers. In fact, there is evidence that whole food-based nutrition may decrease the risk of lung cancer in smokers.

One study showed that a higher intake of green and yellow vegetables or other food sources of beta-carotene decreased the risk of lung cancer. Therefore, smokers should eat these types of foods, but use caution in consuming non-whole-food based supplements that contain beta-carotene or vitamin A.

Some AREDS nutritional formulas specifically for smokers and ex-smokers exclude beta-carotene or contain low-dose amounts.

Note also that some researchers oppose using high-dose vitamin E in a nutritional supplement, while others believe that benefits for people threatened with advanced macular degeneration outweigh potential risks that may be slight.

Step Five: Prevent AMD By Eating More Fish

Research also has shown the benefits of eating fish for macular degeneration prevention:

• A study at the Massachusetts Eye and Ear Infirmary showed that senior men with the highest levels of fish consumption (more than two servings weekly) were 45 percent less likely to have AMD than those who ate the least amount of fish (less than one serving per week).
• Brian Chua and researchers at the University of Sydney demonstrated similar findings. They evaluated 2,900 people aged 49 or older. Participants who ate fish at least once a week were 40 percent less likely to have beginning-stage AMD develop than those who reported eating fish less than once a month or not at all. Those who ate fish at least three times weekly were less likely to have late-stage AMD.

Step Six: Exercise Regularly and Maintain a Healthy Weight

Regular exercise reduces macular degeneration risk, according to a study in the British Journal of Ophthalmology.

In this study, 4,000 people ages 43 to 86 were monitored for 15 years. After considering other risk factors such as weight, cholesterol levels and age, researchers found that people who led an active lifestyle were 70 percent less likely to have AMD develop during the follow-up period.

To be included in the active group, participants must have walked at least two miles a day, three times weekly, or the equivalent.

Step Seven: Eat Fruit and Nuts Daily

Eating fruits and nuts can help reduce your risk of macular degeneration:

• A 2004 study at Harvard Medical School showed that participants who ate three or more servings of fruit daily had a substantially lower risk of "wet" or advanced AMD.
• Another study from the Massachusetts Eye and Ear Infirmary demonstrated that eating nuts helped deter progression of early or intermediate AMD to more advanced stages.

Step Eight: Reduce Refined Carbs in Your Diet

Diets high in refined carbohydrates increase the risk of AMD, which was confirmed in a study published in the American Journal of Clinical Nutrition. Highly refined foods have a high glycemic index, causing a rapid increase in blood sugar and insulin release.

Examples of refined carbohydrates include white bread, white rolls, baked white potatoes, donuts, pretzels and watermelon. Low glycemic index foods include most fruits, spaghetti (especially whole wheat), brown rice, multi-grain and whole grain breads, apple juice and carrot juice.

Step Nine: Control Blood Pressure and Cholesterol

Some evidence indicates that controlling cholesterol can protect you from macular degeneration. Cholesterol is a fatty substance that can build up in blood vessels, inhibiting blood flow necessary for maintaining health of eye tissue.

Also, blood pressure control may be important for macular degeneration prevention. Major investigations including the Framingham Heart and Eye Studies and Beaver Dam Eye Study indicate a significant link between high blood pressure and development of advanced, potentially blinding forms of macular degeneration.

Step Ten: Wear Sunglasses With UV & Blue Light Protection

Major studies show no conclusive evidence that overexposure to the sun directly causes macular degeneration. But some findings suggest at least an association between AMD and cumulative eye damage from overexposure to both UV and high energy visible (HEV) or "blue" light.

As an example, a recent major study found that people who consumed too few antioxidants, in combination with overexposure to blue light, were four times more likely to develop advanced or "wet" AMD. For this reason, it is a good idea to wear sunglasses that protect against both UV and HEV light outdoors.

Step Eleven: Have Regular Eye Exams

Last but not least, have regular eye exams. The American Academy of Ophthalmology recommends a dilated eye exam at least every two to three years if you're between 45 and 60 and every year after the age of 60.

By following these steps, you'll know you've done everything you can to prevent AMD. But if you're strongly genetically predisposed to develop macular degeneration, it still may develop and worsen.

Regular eye exams can help your eye doctor detect AMD and monitor it so that you can receive proper AMD treatment, if appropriate, beyond these preventive measures.

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Resources:

Age-related eye disease study group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta-carotene and zinc for age-related macular degeneration and vision loss. Archives of Ophthalmology. 2001.

Cardiovascular risk factors and age-related macular degeneration: the Los Angeles latino eye study. American Journal of Ophthalmology. February 2008.

Cigarette smoking, fish consumption, omega-3 fatty acid intake, and associations with age-related macular degeneration. Archives of Ophthalmology. 2006.

Comprehensive adult medical eye evaluation, preferred practice pattern. American Academy of Ophthalmology. 2005.

Dietary carbohydrate and the progression of age-related macular degeneration: a prospective study from the age-related eye disease study. American Journal of Clinical Nutrition. 2007.

Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. Eye disease case-control study group. Journal of the American Medical Association. 1994.

Dietary fatty acids and the 5-year incidence of age-related maculopathy. Archives of Ophthalmology. 2006.

Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. The New England Journal of Medicine. 1996.

Eye health: macular degeneration. BMJ Specialist Journals.

Physical activity and the 15-year cumulative incidence of age-related macular degeneration: the Beaver Dam Eye Study. British Journal of Ophthalmology. October 2006.

Progression of age-related macular degeneration: association with dietary fat, transunsaturated fat, nuts, and fish intake. Archives of Ophthalmology. 2003.

Prospective study of intake of fruits, vegetables, vitamins and carotenoids and risk of age-related maculopathy. Archives of Ophthalmology. 2004.

Smoking and blindness. British Journal of Ophthalmology. 2004.

[Page updated January 2011]