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Macular degeneration

MagazineMay 2000 (Vol. 11 Issue 2)Macular degeneration

Q:Although I tried many homoeopathic remedies for cataract, I did not find a cure, so I gave up and had an operation, which was successful

Q:Although I tried many homoeopathic remedies for cataract, I did not find a cure, so I gave up and had an operation, which was successful. However, I now have macular degeneration. I am able to get about, such as to town, via a ten minute ride on a bus that stops outside this building. I have to have any small print photocopied and enlarged. I cannot recognise people across the road and I am terrified of going blind, as I have no family or anyone to care for me.

I have been on two types of multi vitamin supplements made expressly for eyes. I also take a tablet of bilberry, eyebright and gingko for eyes as a general eye care. Do you have a remedy for macular degeneration? SM, Swansea....

A:Macular degeneration is considered so much a part of the ageing process that it is often described as 'age related' (AMD). In this condition, the macula an oval shaped depression in the central part of the retina and the part of the eye with the greatest visual acuity as it distinguishes fine detail in the centre of vision begins to deteriorate. Consequently, people with AMD have a blurred or blind spot directly in the centre of vision.

Although no one is really sure why some people develop AMD, connections have been made between the condition and ultraviolet rays. The macula has most concentrated exposure to sunlight, and it is thought that this light exposure causes oxidation and free radical formation, leading to a breakdown in retinal cells. If you have a habit of being outdoors in bright sunlight in summer, it's important to wear a hat and protective sunglasses.

Smoking has also been linked with AMD so, if you smoke, you should attempt to quit as soon as possible.

Other possible culprits include volatile chemicals, such as those in household cleansers. If you use them frequently, replace them with environmentally friendly brands.

Another possible cause rarely considered is the effect of electromagnetic fields on the eyes. New studies have shown that frequent use of computers can adversely affect the retina. It doesn't sound like you are using computers, but you may wish to have your environment tested for high levels of EMFS; you can do so through PowerWatch (01353 778 814).

You are right to be thinking of nutritional supplements to help your condition. The eyes, like the rest of the body, degenerate when they aren't properly nourished and many nutritional supplements have been shown both to prevent macular degeneration and to stop it from advancing.

We know, for instance, that many of the antioxidants vitamins A, C and E, and selenium and zinc can help to prevent AMD. In one survey, people with a higher consumption of fruits and vegetables rich in vitamin A had a lower risk of AMD, even after adjusting for all other variables (Am J Epidemiol, 1988; 128: 700-10). Another study concluded that people with the highest levels of the antioxidants selenium, vitamin C and vitamin E may have a 70 per cent lower risk of developing AMD (Arch Ophthalmol, 1993; 111: 104-9).

It's important to increase your intake of vitamin A rich fruits and vegetables (carrots, pumpkin, squashes, tomatoes) and also foods rich in vitamins C and E. You should also eat copious amounts of foods such as spinach and kale, which contain the carotenoids lutein and zeaxanthin. One study showed that people eating at least 5.8 milligrams of these antioxidants each day decrease their risk of AMD by 57 per cent (JAMA, 1994; 272; 1413-20).

Animal studies also show that deficiencies of vitamins A or E may be associated with degeneration of the retina

or disruption of photoreceptors (Invest Ophthalmol Vis Sci, 1979; 18: 683-90; Invest Ophthalmol 1974; 13: 499-510). Vitamin C has also been shown to protect against the ageing effects of ultra-violet light in an animal study (Invest Ophthalmol Vis Sci, 1985; 26: 1589-98). (Remember, though, that animal studies don't necessarily apply to humans, which is why WDDTY is against animal testing for this purpose.)

Zinc is the most important mineral for sufferers of AMD, as concentrations of zinc are higher in the retina than in any other organ. According to WDDTY panel member Dr Melvyn Werbach, author of the sourcebook Nutritional Influences on Illness (Tarzana, CA: Third Line Press, 1996), zinc deficiency in the retina may reduce the activity of catalase, an enzyme found in the tissues of the macula.

Reduced activity of this enzyme is associated with AMD (J Am Coll Nutr, 1991; 10: 536). Low levels of zinc in the retina may also interfere with the body's utilisation of vitamin A (J Nutr, 1975; 105: 1486-90).

In one double blind study of 151 patients, those given zinc suffered significantly less loss of visual acuity than those given a placebo after one or two years (Arch Ophthalmol, 1988; 106: 192-8).

Besides zinc, copper is also vital to the retina; however, in this condition, copper levels are often elevated, which can prove toxic to the macula (India J Ophthalmol, 1981; 29: 351-3). Taking the Pill or HRT can cause abnormally high copper levels in women (Stephen Davies, Nutritional Medicine, Pan, 1987). High levels of copper can also affect the levels of zinc in your body, and elevated blood levels of either mineral are linked with AMD (Ann Ophthalmol, 1985; 17: 419-22). So, if you're on or have been on HRT, you might wish to get your copper levels checked.

One final important nutrient is the amino acid taurine, which is necessary for normal vision and lost when you are exposed to bright light. Studies have shown that a deficiency of taurine can bring on degeneration of the retina (Science, 1975; 188: 949-51).

There's no doubt that taking certain vitamins and minerals can even help slow or reverse the disease in those who have already developed the condition.

In one small study of 20 patients, 90 per cent improved after receiving vitamin E and replacing table salt with sea salt, which is rich in natural minerals. One fifth of the patients, who had only able to make out hand movements, enjoyed such improvements in vision that they were able to read newspapers again. These improvements carried on only so long as they took the supplements, suggesting that people with AMD may have higher requirements for antioxidants and certain minerals (Todd GP, Nutrition, Health & Disease, Norfolk, Virginia: The Donning Company, 1988).

The best results occur when patients are given a combination of the nutrients known to be vital to a well functioning retina. In one study, patients' vision improved when they were given a supplement of vitamins C and E, copper, manganese, selenium, beta carotene (a precursor of vitamin A) and riboflavin (vitamin B2) (J Am Coll Nutr, 1991; 10: 550). In another study, progression of the disease was slowed down with vitamins A, C and E plus selenium, with the best results among those where treatment was started early (Prevention, March 1985: 74-80).

Although you are already taking a specially prepared eye supplement, most of the brands we've investigated (including the brand you use) don't include enough of the individual nutrients or herbs to really make much of a difference to patients who have already developed a disease. This tends to be a problem with many of the combination supplements. Vitamin companies throw in a little of this and a little of that, but not enough of anything to make much of a difference to your health. In cases like yours, you really need very high doses of a number of nutrients.

For instance, the daily dose of your supplement contains 50 milligrams of zinc, 50 micrograms of selenium, 200 international units of vitamin E and 300 milligrams of vitamin C.

But in possibly the best study to date of AMD patients, they improved on daily doses that were two or three times higher: intravenous daily injections of selenium (400 micrograms) and zinc (10 milligrams) plus oral selenium (200-300 micrograms) and oral zinc picolinate or citrate (60 milli grams), 800 international units of vitamin E and 1 gram of taurine. After eight weeks, patients stopped the injections and relied only on oral supplements of selenium 800 micrograms and zinc 20 milligrams weekly, which was slowly tapered off if possible. All but one of the patients improved (J Nutr Med, 1990; 1: 133-8).

If you are taking high dose supplements of vitamin C, it's particularly important to avoid bright sunlight. One study showed that humans exposed to excessive high energy light combined with high doses of ascorbic acid (vitamin C) developed AMD (J Am Coll Nutr, 1991; 10: 550). You also need to take a copper supplement since copper may also be depleted by vitamin C.

If you are taking supplements of vitamin E, it's vital that you also supplement with vitamin A. Research has demonstrated that low levels of vitamin E inferfere with the body's uptake of vitamin A (Mech Ageing Dev, 1986; 35: 291-305); in an animal study of rats made deficient in vitamin E, levels of vitamin A in their diet determined the extent of the damage to the retina (Invest Ophthalmol Vis Sci, 1979; 18: 683-90).

Besides nutritional supplements, certain herbs, as you' know, can help AMD, but not at the low doses you're taking. To be effective, at least 160-480 milligrams of bilberry needs to be taken with an anthocyanidin content of 25 per cent (J Klin Monatsbl Augenheikd, 1981; 178: 386-9).

Ginkgo biloba can also help AMD, but you must take at least 40 milligrams three times a day to improve, and the herb must contain 24 per cent ginkgoflavonglycosides, the active ingredient.

Nutritional healing is a complicated undertaking requiring a great deal of knowledge. We recommend that, if possible, you see a qualified nutritionist or nutritional doctor with experience in successfully treating AMD who can tailor your supplement programme specifically to your needs.


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