Nutritionand YourEyesightAnswering Your Questions About Age-Related Macular Degeneration (AMD)and Nutritional Supplements

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Vision is considered the most preciousof the senses. But a major threat tovision is a condition called age-relatedmacular degeneration, or AMD. AMDis the leading cause of vision loss inAmericans over age 60.

And, it affects millions of peopleworldwide.

But you might be surprised to knowthat taking certain vitamins andminerals may help keep AMD fromstealing your vision. This brochurehelps you understand how.

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What is AMD?AMD is a disease that gradually destroys youreyesight. It affects your ability to see thingsclearly. Everyday activities such as watchingtelevision, reading, and driving may becomedifficult, then impossible. You may havedifficulty recognizing faces or seeing doorwaysor stairs.

In some people, AMD happens so slowly thatthey don’t even notice the symptoms at first. Inothers, it progresses more rapidly.

AMD affects the macula (MACK-you-la), whichis the part of your eye that creates sharp visionand makes it possible for you to see details. The condition is painless, but the effects can be devastating.

Cutaway view of the eye

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What are the symptoms of AMD?There are two types of AMD: dry, or non-exudative (ex-you-DATE-iv), AMD; and wet, or exudative, AMD.

Dry AMD, which is by far the more commontype, happens when cells in the macula thatidentify light start to break down. Earlysymptoms of dry AMD are slightly blurredvision, the need for more light when trying tosee things up close, or mild distortions whenlooking at objects with detail.

Wet AMD happens when abnormal bloodvessels under the macula start to leak bloodand fluid, which damages the macula. Anearly symptom of wet AMD may be whenstraight lines seem to look wavy.

As AMD progresses, your vision may becomevery unclear, and you may lose your ability tosee colors. A blurry or dark or empty area mayappear in the center of your vision.

Early diagnosis of AMD is crucial to avoidingsevere loss of vision. See your eye doctor assoon as possible if you have any symptoms.

The same scene viewed bya person with AMD

A scene viewed by a personwith normal vision

Photos: National Eye Institute. Facts About Age-Related Macular Degeneration.http://www.nei.nih.gov/health/maculardegen/armd_facts.asp.

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What are the risk factors for AMD?The greatest risk factor for AMD is age, which,of course, you can’t change. The disease usuallyaffects people over age 60. Other risk factorsthat you can’t change include race (whites areat higher risk), sex (women are at higher risk),and having a family history of AMD. Risk factorsthat you can change include smoking, highblood pressure, high cholesterol, and obesity.And while you cannot change your genes, if youhave a high genetic risk for AMD, a diet high inantioxidants could reduce your risk.

A common early sign of AMD is the formation ofdrusen (DROO-zen), abnormal yellow depositsunder the retina of the eye. The retina is thetissue at the back of your eye that senses lightand sends messages to your brain. Your eyedoctor can detect drusen during an examinationwhen the pupils of your eyes are dilated.

There are three stages of AMD:Early AMD, in which there is small drusenbut no vision lossIntermediate AMD, in which there ismedium-sized drusen or one or more largedrusen, but little or no vision loss

�drusen

Advanced AMD, in which there is largedrusen and a breakdown of the cells inthe macula that identify light (dry AMD)or leaking blood vessels under themacula (wet AMD), accompanied byvision loss that keeps getting worse

Your eye doctor will tell you about your riskfor developing advanced AMD and what youcan do for it.

Why is early treatmentimportant?Sadly, there is no way to cure AMD once itstarts. But the good news is that there areways to slow it down if it does occur.

Dry AMD can turn into wet AMD. In fact,nearly all people who have wet AMD have haddry AMD first. Although both types can impairyour vision, the most significant vision losscomes from the wet form. So it makes sensethat the odds of preserving your vision arebetter if you can help keep dry AMD fromturning into wet AMD. That’s why earlytreatment is so important.

Researchers have discovered that certainvitamins and minerals can play a big role inthe early treatment of AMD. They may helpdelay it or prevent it from progressing.

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How can vitamins and mineralshelp eyesight?According to the American OptometricAssociation, including certain nutrients in yourdiet every day can help save your vision.Researchers have found that nutrients such aslutein (LOO-teen), zeaxanthin (zee-uh-ZAN-thin), vitamin C, vitamin E, and zinc can reducethe risk of certain eye diseases, including AMD.

In 2001, the National Eye Institute sponsored amajor research study called the Age-RelatedEye Disease Study (AREDS). This importantstudy concluded that if you have intermediateor advanced AMD, taking an antioxidantvitamin or mineral supplement could help slowAMD’s damaging effects on your vision. Thesupplements studied included vitamins C and E,beta-carotene, zinc, and copper.

A follow-up to the original AREDS trial, AREDS2,began in June 2008 and is expected to take fiveyears to complete. The AREDS2 trial is lookingat refining the original AREDS formula. It isstudying whether omega-3 fatty acids, as wellas the nutrients lutein and zeaxanthin, alsocould play a role in maintaining healthy eyes.

Early AMD could be a sign of poor dietarychoices throughout life. While there is noproven treatment to prevent AMD, ongoingresearch is showing that adequate amounts ofcertain vitamins and minerals can make adifference in preserving precious vision.

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FREQUENTLY ASKED QUESTIONS

Nutritional Supplementsabout AMDand

Can my diet alone provide the vitamins and minerals I need for preventing AMd from advancing?

Studies have suggested that people who havediets rich in green leafy vegetables andomega-3 fatty acid food sources have a lowerrisk of developing AMD. Leafy greenvegetables include kale, spinach, turnip, andcollard greens. Eggs and colorful fruits andvegetables, such as yellow peppers and corn,are good sources of lutein and zeaxanthin.High amounts of omega-3 fatty acids are bestfound in fatty fish such as tuna, salmon, andsardines. The high levels of vitamins andminerals recommended in the AREDS study forthose with moderate or more advanced AMDare difficult to get from your diet alone. In thiscase, dietary supplements may be helpful.

What are the best supplements to take for AMd?

Experts say that people at high risk fordeveloping advanced AMD should considertaking the combination of nutrients used inthe AREDS and AREDS2 studies.

The AREDS formulation is available at drugstores, supermarkets, and other retail stores.The specific daily amounts of antioxidantsand zinc tested in the original AREDS clinicaltrial included the following:

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500 milligrams (mg) of vitamin C400 International Units (IU) ofvitamin E15 mg of beta-carotene, often labeled as theequivalent of 25,000 IU of vitamin A (but thissupplement should be avoided by smokers)80 mg of zinc (as zinc oxide)2 mg of copper (as cupric oxide)

There is growing evidence that omega-3 fattyacids, along with lutein and zeaxanthin, can helpreduce AMD risk. These nutrients are beinginvestigated in the ongoing AREDS2 study, andsome AREDS2 formulations are now available.They include the original AREDS formulation (butwithout beta-carotene and with a reduced zincdosage) along with the following:

1000 mg of omega-3 fatty acids10 mg lutein2 mg zeaxanthin

Are there options other than the Areds or Areds2 formulations?

Talk with your eye doctor about whether youshould be taking one of the AREDS formulationsand/or other vitamins and minerals. Even if youdon’t need an AREDS-like formula, there areother options and formulas available. Somepeople shouldn’t take the AREDS formulabecause of potential interactions with othermedications they may be taking or with other sensitivities.

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FREQUENTLY ASKED QUESTIONS

Nutritional Supplementsabout AMDand

Who should take supplements to helpprevent AMd from advancing?

The American Optometric Association statesthat dietary supplements may be mostappropriate for people who:

show early evidence of AMDare over age 50have a family history of AMDdon’t get adequate nutrition from their daily diet

Other people may also benefit from takingAMD-related supplements. While there is noguarantee that supplements will help AMD ineveryone, studies have shown that they mayhelp prevent the disease from advancing.Recent studies have shown that goodnutrition may actually improve vision inpeople with AMD.

Are there any side effects from taking these supplements?

Most people can take supplements for AMDin recommended doses without a problem.Taking mega-doses of certain vitamins orminerals, such as high doses of vitamin E forsome men, could be unsafe. Your eye doctorcan suggest dosages that are appropriate for you.

Some people in the AREDS study reportedcertain side effects related to zinc, such asurinary tract problems. A small number ofothers who took large doses of beta-carotenereported temporary yellowing of their skin.

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should I also take a multivitamin if I take an Areds formulation?

Multivitamins contain many important nutrientsthat are not found in the AREDS formulations. Soyou may want to take a multivitamin along withthe AREDS formulation. In fact, people in theAREDS trial who took a multivitamin had betterresults. However, be sure to review all thevitamins you take with your eye doctor before youbegin an AREDS formulation, so that you’re nottaking too much of any one particular vitamin.

Wasn’t there a study that said taking vitaminswasn’t as helpful as once thought, and couldeven be dangerous?

The Iowa Women’s Health Study, published in2011, indicated that several commonly useddietary vitamin and mineral supplements could bedangerous. The methods of this study, however,have been questioned by other experts. Forexample, the study involved only older whitewomen and examined only a small number ofvitamins and minerals. It did not look specifically atlutein and zeaxanthin or at omega-3 fatty acids,and there is no evidence that these nutrientshave any negative effects. The researchersconcluded their study by recommending thatdietary supplements continue to be used inpeople with a medical need for them.

How do I know which supplement is best for me?

Because there are a number of products on themarket, choosing the right one for you can beconfusing. Not all supplements available in storesare made by companies that scientifically testtheir products. Ask your eye doctor to recommendthe specific supplements that are best for you.

Jeffry D. Gerson, OD, FAAOWestGlen Eyecare , Shawnee, Kansas

Mark T. Dunbar, OD, FAAODirector of Optometric Services/Optometry Residency SupervisorBascom Palmer Eye Institute, University of Miami

Miller School of Medicine, Miami, Florida

Leo P. Semes, OD, FAAO, FACMOProfessor, Optometry; Clinical Assistant ProfessorUAB School of Nursing, School of Optometry, The University of

Alabama at Birmingham, Birmingham, Alabama

Diana L. Shechtman, OD, FAAOAssociate ProfessorNova Southeastern University College of OptometryFort Lauderdale-Davie, Florida

Kirk L. Smick, OD, FAAOChief of Optometry ServicesClayton Eye Center, Morrow, Georgia

© 2012 MedEdicus LLC

EDITORIAL ADVISORY BOARD FOR THIS BROCHURE

For additional information, visit:

American Academy of Optometrywww.aaopt.org

American Optometric Associationwww.aoa.org

national eye Institutewww.nei.nih.gov

Ocular nutrition societywww.ocularnutritionsociety.org

This brochure was made possible through aneducational grant from Bausch and Lomb

The content of this brochure is not meantto replace the advice of your physician.Please seek the advice of your physician orother qualified health provider with anyquestions or for recommendations.