Macular Degeneration treatment, herbs, vitamins, supplements, natural and alternative treatment by Ray Sahelian, M.D.
Feb 18 2014


Age related macular degeneration is an eye disorder that can result in irreversible visual loss and is the commonest cause of blindness in the Western world.
The retina is particularly susceptible to oxidation as its need for oxygen is large, it is exposed to high levels of light, and its membranes are rich in readily oxidized polyunsaturated fatty acids, particularly DHA found in fish oils.
   ARMD appears to share several carbohydrate-related mechanisms and risk factors with diabetes-related diseases, including retinopathy and cardiovascular disease. This indicates that a healthy diet over a lifetime with good blood sugar control would reduce the risk of this eye condition. People who smoke cigarettes are several times more likely to develop this eye disorder than non-smokers. Regular, daily use of aspirin may also increase the risk, (The Association of Aspirin Use With Age-Related Macular Degeneration, JAMA Intern Med. 2013) thus a baby aspirin two or three times a week seems to be a better approach than a full pill a day.

Macular Degeneration treatment options, natural vitamins, herbs, alternative remedies
Macular degeneration is a condition in which there is progressive deterioration of the central area of the retina, resulting in gradual sight loss in the center of the field of vision. AMD is a multi-faceted condition which ultimately leads to blindness in millions of people worldwide. The pathophysiology and risk factors for AMD are complex, and the symptoms manifest in multiple related but distinct forms.
    
Treatment is still evolving  and advancing but little research is focused on natural approaches.  Some basic nutritional therapies are being overlooked. For instance vitamin therapy is not used by eye specialists as much as it should. I have tried to gather as much information as I can regarding natural ways to treat or prevent macular degeneration.

Eyesight Rx, Supports Healthy Vision

Unlike some vision products that provide nutrients and herbs for long term healthy vision support, and prevention of visual impairment, but don't seem to have much of an immediate effect on visual acuity, Eyesight Rx was formulated to provide a quick and noticeable eyesight improvement within hours.

Reports from Eyesight Rx users indicate enhanced clarity of vision, colors being brighter, better focus, and overall improvement in close and distance vision. We've had reports of some people noticing this effect within 10 minutes, while most people notice improved eyesight within hours. Still others will realize their vision is sharper the next morning when they take their second dose.

 

 

Supplement Facts:
Vitamin C (Ascorbic acid)
Citrus bioflavonoids (eriocitrin, hesperidin, flavonols, flavones, flavonoids, naringenin, and quercetin)
Mixed carotenoids (astaxanthin, beta carotene, cryptoxanthin, lutein,
lycopene, zeaxanthin)
Bilberry extract (Vaccinium myrtillus)
Jujube extract (Zizyphus jujube)
Ginkgo biloba (Ginkgo biloba)
Suma extract (Pfaffia paniculata)
Mucuna pruriens extract
Cinnamon (Cinnamomum zeylanicum)
Lycium berry extract (Lycium Barbarum) also known as gobi berry. Studies show that ingestion of goji berries increases zeaxanthin levels and may help reduce the risk for ARMD.
Sarsaparila (Sarsaparilla Smilax)
Alpha Lipoic acid strong antioxidant

Testimonial
I use Eyesight Rx two days and then one day not. I had a little macula degeneration, but I am very glad to report that since using Eyesight Rx it has remained stable. I have not noticed any negative side effects. Thank you for your eye formula!

My mother is 78 years old. Since last two years diagnosed with Macular Degenerative disease and have lost her 75% vision. She cannot identify a person if the person is two feet away from her. She can see that someone is standing there. The Eye doctor have performed two surgeries on her both eyes for cataract and have inserted lens but there is no luck with the good vision. Do you think if she take Eyesight Rx her vision will improve? If yes what should be dosage?
    It is not possible for us to predict whether any treatment, natural or by prescription, will help her. However, if her doctor approves, she can try half a tablet daily for a few days then every other day.

Diet and macular degeneration
Diet has a strong influence on the course of macular degeneration. Eating fish or taking fish oils supplements could reduce the risk for macular degeneration. Fish intake, the major source of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), has been shown in studies to reduce the risk of ARMD. Consume more fresh fruits and vegetables which contain lots of flavonoids and carotenoids. Vitamin D may also be helpful in reducing the risk of age-related macular degeneration.
   High omega-6 intake may be particularly harmful, to the extent that it can "mask" any positive effects of omega-3 intake. Archives of Ophthalmology, November 2009.

Several epidemiologic studies and clinical trials suggest that diets high in antioxidant nutrients (vitamins C and E, carotenoids such as lutein and zeaxanthin, fruit and vegetables that contain these nutrients, and nonnutritive antioxidants) or zinc are associated with a decreased occurrence of early or late age related macular degeneration. A high dietary intake of fat is associated with a higher prevalence or incidence.

Diets with good amounts of omega-3-fatty acids slow the progression of early age-related macular degeneration. The findings are based on a review of data from 2924 subjects who were enrolled in the Age-Related Eye Disease Study (AREDS) and were randomly assigned to receive one of four dietary supplement groups: placebo, antioxidants, zinc, or antioxidants plus zinc. Volunteers completed food frequency questionnaires at the beginning of the study and underwent periodic general and ophthalmologic physical examinations, Dr. C-J. Chiu, from Tufts University, Boston, found that regardless of which supplement was given, higher quantities of omega fatty acids lowered the risk of progression to advanced macular degeneration. In addition, a lower dietary glycemic index correlated with a 24 percent reduced risk of progression. British Journal of Ophthalmology, 2009.

Dr. John Paul SanGiovanni of the National Eye Institute at the National Institutes of Health in Bethesda, Maryland, evaluated 1,837 people who had early signs of AMD. He found those with the highest consumption of omega-3 fatty acids were 30 percent less likely to progress to the advanced form of the disease over a 12-year period than those with the lowest omega-3 intake, researchers found. Dr. John Paul SanGiovanni analyzed data from the Age-Related Eye Disease Study, a clinical trial run by the National Institutes of Health to investigate nutrition-based approaches to preventing and treating AMD. People who consumed the largest amounts of the two main dietary types of omega-3 fatty acids -- docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) -- were about 30 percent less likely to develop either wet or dry AMD than people with the lowest intake. American Journal of Clinical Nutrition, 2009.

Goji berry supplementation increases plasma zeaxanthin and antioxidant levels as well as protects from hypopigmentation and soft drusen accumulation in the macula of elderly subjects. Goji berry effects on macular characteristics and plasma antioxidant levels. Optom Vis Science. 2011.

Nutrients and herbs that could be of benefit
Vitamin E Evidence from in vitro and animal studies suggests that the antioxidants Vitamins C and natural Vitamin E complex can protect the retina against photochemical damage. Vitamin E in the range of 30 to 200 units a few times a week of the mixed tocopherols and tocotrienols is a good option. It is not necessary to take vitamin E daily since it is stored in fat tissue.

Vitamin C with bioflavonoids 100 to 500 mg a day.

Vitamin D through sun exposure or taking 400 units to 1000 units a day could be of benefit in reducing the risk for ARMD.

R- Alpha Lipoic acid 10 to 50 mg a few times a week, in the morning with breakfast. R- alpha lipoic acid is quite a powerful antioxidant and can improve vision in some people.
Many studies have shown that antioxidant supplements, such as alpha lipoic acid help reduce the progression of macular degeneration.

Carotenoids
also have antioxidant properties and reduce the risk of retinal cells from being oxidized and damaged. Two of these carotenoids, Lutein and Zeaxanthin, are particularly important.
    
Lutein and Zeaxanthin make up the macular pigment that is thought to limit retinal oxidative damage by filtering out blue light. Supplementation with lutein has been shown to improve macular degeneration. In a study of healthy women younger than 75 years, consumption of diets rich in lutein and zeaxzanthin, which are found in green leafy vegetables, corn, and squash, seemed to stave off intermediate age-related macular degeneration. The researchers' findings appear in the August, 2006 issue of Archives of Ophthalmology.

Macular carotenoids: lutein and zeaxanthin.
Dev Ophthalmology. 2005.
The yellow color of the macula lutea is due to the presence of the carotenoid pigments lutein and zeaxanthin. In contrast to human blood and tissues, no other major carotenoids including beta-carotene or lycopene are found in this tissue. The macular carotenoids are suggested to play a role in the protection of the retina against light-induced damage. Protecting ocular tissue against photooxidative damage carotenoids may act in two ways: first as filters for damaging blue light, and second as antioxidants quenching excited triplet state molecules or singlet molecular oxygen and scavenge further reactive oxygen species like lipid peroxides or the superoxide radical anion.

Reference: Indian J Ophthalmol. Oct 30, 2013. Dietary and lifestyle risk factors associated with age-related macular degeneration: A hospital based study.

Exercise
Keeping an active lifestyle can reduce the risk of developing
macular degeneration. Physical activity such as walking and climbing stairs has a protective effect . Exercise helped to reduce the odds of suffering from wet," or exudative, AMD a form of the condition in which new blood vessels grow behind the eye causing bleeding and scarring which leads to distorted vision and impaired sight.

Cause of macular degeneration
Normal damage to cells in the eye as we age. Poor diet over the years, diabetes or poor blood sugar control, excessive sun exposure, lack of adequate omega 3 oils or fish oils in the diet.
Smoking contributes to macular degeneration. Older adults who smoke are twice as likely to suffer from macular degeneration as their non-smoking peers. Genetics is probably another cause of macular degeneration.
   Smoking cigarettes, or living with someone who does, increases a person's risk.
   A newly discovered cause of macular degeneration are statin drugs. See the study below.
   The herb St. John's wort may be phototoxic to the retina if used for prolonged periods and eyes exposed to sunlight. Those with macular degeneration may wish to avoid the use of St. John's wort if they are exposed to strong sunlight daily.
   A combination of sunlight exposure and low blood levels of antioxidants may make older adults more vulnerable to AMD.
   Daily use of aspirin for several years may increase the risk.

Klin Oczna. 2013. Age-related macular degeneration as a local manifestation of atherosclerosis - a novel insight into pathogenesis. We speculate that vascular atherosclerosis and age-related macular degeneration may represent different manifestations of the same disease induced by a pathologic tissue response to the damage caused by oxidative stress and local ischemia. In this review, we characterise in detail a strong association between age-related macular degeneration and atherosclerosis development, and we postulate the hypothesis that ARMD is a local manifestation of a systemic disease.

Symptoms and Signs
Age-related macular degeneration is a chronic eye disease that occurs when tissue in the macula, the part of your retina that's responsible for central vision, deteriorates. Degeneration of the macula causes blurred central vision or a blind spot in the center of your visual field. The first sign may be a need for more light when you do close-up work. Fine newsprint may become harder to read and street signs more difficult to recognize. Gray or blank spots may mask the center of your visual field. Macular degeneration affects your central vision, but not your peripheral vision; thus it doesn't cause total blindness. Still, the loss of clear central vision critical for reading, driving, recognizing people's faces and doing detail work greatly affects your quality of life.
    
Macular degeneration of the eye
 may be recognized by a physician in its early stages by the appearance (with an opthalmoscope) of pigment changes and drusen within the retina.

Statin drugs
Cholesterol-lowering statin drugs (such as Lipitor or Zocor) do not appear to stave off age-related macular degeneration in the eye. In fact, a review of data from the Cardiovascular Health Study suggests that taking a statin may slightly increase the risk. Archives of Ophthalmology, 2006.

Macular Degeneration Research and Treatment studies
Associations between intermediate age-related macular degeneration and lutein and zeaxanthin in the Carotenoids in Age-related Eye Disease Study (CAREDS): ancillary study of the Women's Health Initiative.
Arch Ophthalmol. 2006.
Women aged 50 to 79 years in Iowa, Wisconsin, and Oregon with intake of lutein plus zeaxanthin above the 78th (high) and below the 28th (low) percentiles at baseline in the Women's Health Initiative Observational Study were recruited 4 to 7 years later into the Carotenoids in Age-Related Eye Disease Study (CAREDS), when the presence of AMD was determined by fundus photographs. The prevalence of intermediate AMD was not statistically different between the high and low lutein plus zeaxanthin intake recruitment groups after adjusting for age. Limiting analyses to women younger than 75 years with stable intake of lutein plus zeaxanthin, without a history of chronic diseases that are often associated with diet changes, substantially lowered odds ratios. Exploratory analyses of advanced AMD in 34 participants resulted in protective, but statistically nonsignificant, associations in the overall sample and in women younger than 75 years. Diets rich in lutein plus zeaxanthin may protect against intermediate AMD in healthy women younger than 75 years.

Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetylcarnitine, n-3 fatty acids, and coenzyme Q10.
Ophthalmologica. 2005.
The aim of this randomized, double-blind, placebo-controlled clinical trial was to determine the efficacy of a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10 on the visual functions and fundus alterations in early age-related macular degeneration. The mean change in parameters of visual functions showed significant improvement in the treated group by the end of the study period. Decrease in drusen-covered area of treated eyes was also statistically significant as compared to placebo when either the most affected eyes or the less affected eyes were considered. These findings strongly suggested that an appropriate combination of compounds which affect mitochondrial lipid metabolism, may improve and subsequently stabilize visual functions, and it may also improve fundus alterations in patients affected by early macular degeneration.

Dietary supplementation with bilberry extract prevents macular degeneration and cataracts in senesce-accelerated OXYS rats.
Adv Gerontol. 2005.
Cataracts and macular degeneration remain the major cause of blindness and acuity of vision deterioration in the elderly. Both pathology have been attributed to damage by free radicals, there has been a great deal of interest in antioxidants. Bilberry's flavonoids are known as potent antioxidants, scavenging free radicals and used for multiple age-releted ocular disorders. There are no experimental studies, devoted to estimation of bilberry effect. To explore this one the senescence-accelerated OXYS rats with early senile cataract and macular degeneration were used. From 1.5 to 3 month OXYS rats were given control diets or those supplemented with 25% bilberry extract (BE, 20 mg on kg of body weight including 4.5 mg of antocianidin) or vitamin E (40 mg/kg) as drag for comparison. The testing at 3 month have showed that more then 70% of control OXYS rats had cataract and macular degeneration while the supplementation of BE completely prevented impairments in the lenses and retina. The VE had no significant effects but both antioxidants decreased lipid peroxides in the retina and serum of OXYS rats. The results suggest that the OXYS rat strain is the useful model for macular degeneration and senile cataract and long-term supplementation with bilberry extract is effective in prevention of macular degeneration and cataract.

Resveratrol reduces oxidation and proliferation of human retinal pigment epithelial cells via extracellular signal-regulated kinase inhibition.
Chem Biol Interact. 2005. Department of Food Science and Technology, Ohio State University, Columbus, OH
Development of age-related macular degeneration and other retinal diseases, such as proliferative vitreoretinopathy (PVR), is associated with oxidative stress in the retinal pigment epithelium (RPE), a cell layer responsible for maintaining the health of the retina by providing structural and nutritional support. We hypothesize that resveratrol, a red wine polyphenol, may be responsible, in part, for the health benefits of moderate red wine consumption on retinal disease. To test this hypothesis, the antioxidant and antiproliferative effects of resveratrol were examined in a human RPE cell line (designated ARPE-19). These results suggest that resveratrol can reduce oxidative stress and hyperproliferation of the RPE.

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.
The objective of the lutein antioxidant supplementation trial (LAST) is to determine whether nutritional supplementation with lutein or lutein together with antioxidants, vitamins, and minerals, improves visual function and symptoms in atrophic Age-related macular degeneration. The study was a prospective, 12-month, randomized, double-masked, placebo-controlled trial conducted at an urban midwestern Veterans Administration Hospital from August 1999 to May 2001. Ninety patients with atrophic macular degeneration were referred by ophthalmologists at two Chicago-area veterans medical facilities. Patients in Group 1 received lutein 10 mg; in Group 2, a lutein 10 mg/antioxidants/vitamins and minerals broad spectrum supplementation formula (L/A); and in Group 3, a maltodextrin placebo over 12 months.  In this study, visual function in macular degeneration is improved with lutein alone or lutein together with other nutrients. Further studies are needed with more patients, of both genders, and for longer periods of time to assess long-term effects of lutein or lutein together with a broad spectrum of antioxidants, vitamins, and minerals in the treatment of atrophic age-related macular degeneration.

Fasting plasma zeaxanthin response to Fructus barbarum (wolfberry; Kei Tze) in a food-based human supplementation trial.
Br J Nutr. 2005.
Lycium barbarum is a small red berry known as Fructus lycii and wolfberry in the West, and Kei Tze and Gou Qi Zi in Asia. Wolfberry is rich in zeaxanthin dipalmitate, and is valued in Chinese culture for being good for vision. The aim of this study, which was a single-blinded, placebo-controlled, human intervention trial of parallel design, was to provide data on how fasting plasma zeaxanthin concentration changes as a result of dietary supplementation with whole wolfberries. This human supplementation trial shows that zeaxanthin in whole wolfberries is bioavailable and that intake of a modest daily amount markedly increases fasting plasma zeaxanthin levels. These new data will support further study of dietary strategies to maintain macular pigment density.

Biologic Mechanisms of the Protective Role of Lutein and Zeaxanthin in the Eye.
Annu Rev Nutr 2003. Department of Biochemistry, Tufts University Medical School, Boston, MA
The macular region of the primate retina is yellow in color due to the presence of the macular pigment, composed of two dietary xanthophylls, lutein and zeaxanthin, and another xanthophyll, meso-zeaxanthin. By absorbing blue-light, the macular pigment protects the underlying photoreceptor cell layer from light damage, possibly initiated by the formation of reactive oxygen species during a photosensitized reaction. There is ample epidemiological evidence that the amount of macular pigment is inversely associated with the incidence of age-related macular degeneration, an irreversible process that is the major cause of blindness in the elderly. The macular pigment can be increased in primates by either increasing the intake of foods that are rich in lutein and zeaxanthin, such as dark-green leafy vegetables, or by supplementation with lutein or zeaxanthin. While the concept that increasing the intake of lutein or zeaxanthin might prove to be protective against the development of age-related macular degeneration, a causative relationship has yet to be experimentally demonstrated.

Prospective study of intake of fruits, vegetables, vitamins, and carotenoids and risk of age-related maculopathy.
Arch Ophthalmol. 2004.
We conducted a prospective follow-up study of women in the Nurses' Health Study and men in the Health Professionals Follow-up Study. We followed 77 562 women and 40 866 men who were at least 50 years of age and had no diagnosis of macular degeneration or cancer at baseline for up to 18 years for women and up to 12 years for men. Fruit and vegetable intakes were assessed with a validated semiquantitative food-frequency questionnaire up to 5 times for women and up to 3 times for men during follow-up. A total of 464 (329 women and 135 men) incident cases of early macular degeneration and 316 (217 women and 99men) cases of neovascular macular degeneration, all with visual loss of 20/30 or worse due primarily to macular degeneration, were diagnosed during follow-up. Fruit intake was inversely associated with the risk of neovascular macular degeneration. Participants who consumed 3 or more servings per day of fruits had a pooled multivariate relative risk of 0.64 compared with those who consumed less than 1.5 servings per day. The results were similar in women and men. However, intakes of vegetables, antioxidant vitamins, or carotenoids were not strongly related to either early or neovascular macular degeneration. These data suggest a protective role for fruit intake on the risk of neovascular macular degeneration.

Chemistry, distribution, and metabolism of tomato carotenoids and their impact on human health.
Exp Biol Med. 2002.
The most abundant carotenoid in tomato is lycopene, followed by phytoene, phytofluene, zeta-carotene, gamma-carotene, beta-carotene, neurosporene, and lutein. Detailed qualitative and quantitative analysis of human serum, milk, and organs, particularly prostate, have revealed the presence of all the aforementioned carotenoids in biologically significant concentrations. Two oxidative metabolites of lycopene, 2,6-cyclolycopene-1,5-diols A and B, which are only present in tomatoes in extremely low concentrations, have been isolated and identified in human serum, milk, organs (liver, lung, breast, liver, prostate, colon) and skin. Carotenoids may also play an important role in the prevention of age-related macular degeneration, cataracts, and other blinding disorders. Among 25 dietary carotenoids and nine metabolites routinely found in human serum, mainly lutein, zeaxanthin, lycopene, and their metabolites were detected in ocular tissues. In this review we identified and quantified the complete spectrum of carotenoids from pooled human retinal pigment epithelium, ciliary body, iris, lens, and in the uveal tract and in other tissues of the human eye to gain a better insight into the metabolic pathways of ocular carotenoids. Although lutein, zeaxanthin, and their metabolites constitute the major carotenoids in human ocular tissues, lycopene and a wide range of dietary carotenoids have been detected in high concentrations in ciliary body and retinal pigment epithelium.

Plasma homocysteine and total thiol content in patients with exudative age-related macular degeneration.
Eye. 2005.
Elevated homocysteine levels have been associated in the development of several vascular diseases. Vascular and oxidative stress theories have been implicated for the development of choroidal neovascularization in exudative macular degeneration. The aim of the present study was to investigate the possible role of plasma homocysteine and thiol content (tSH) as a risk factor for the development of exudative macular degeneration. Results from our present study revealed that there is an elevated homocysteine level and diminished thiol pool content in exudative age related macular degeneration that are significant.

Symptom
Loss of central vision is the most serious symptom. The first sign or symptom may be a need for more light during close-up work. Fine newsprint may become harder to read and street signs, particularly at night, more difficult to recognize. Gray or blank spots may mask the center of your visual field. Symptoms of macular degeneration usually develop gradually, but may sometimes progress rapidly, leading to severe vision loss in one or both eyes. There are two major types wet and dry.

Treatment
Photodynamic therapy is a new treatment modality available for choroidal neovascularisation (CNV) secondary to age-related macular degeneration.
ARMD is an eye disorder that can result in irreversible visual loss and is the commonest cause of blindness in the Western world.

New Macular Degeneration Drug information
Lucentis treats the wet form of age-related macular degeneration, a disorder where blood vessels behind the retina leak blood and fluid, worsening vision and often causing blindness. An estimated 90 percent of the 1.4 million Americans who have lost their eyesight due to the disorder have the wet form. Lucentis, made by the South San Francisco, Calif., biotechnology company Genentech Inc., inhibits the growth of blood vessels when injected into the eye.

Age Related Macular Degeneration Treatment with vitamins, herbs and supplements questions
Does CoQ10 help?
   I am not aware of CoQ10 having been tested as a treatment option.

My partner has aged related macular degeneration and is also on medication for blood pressure, cholestoral and gout. Would Eyesight-Rx be of help to his sight. I think he has the dry type AMD.
   We cannot predict any person's response to a particular supplement. If your partner plans to use Eyesight Rx for macular degeneration, a low dose should be tried.

Can a person take serrapeptase if they have macular degeneration?
   Not enough is known about this interaction to give any advice on using serrapeptase in those who have macular degeneration.

I got 2 bottles of Eyesight Rx, a great product, does seem to help with my macular degeneration. Eyesight Rx has clearly helped my color perception and clarity. I believe Eyesight Rx is probably the best product of its kind. I was so excited to find it and try it, and am interested in promoting it to others with vision problems.

I went through your website, as my optomotrist recommends that I begin using I-Caps on a regular basis (due to the onset of dry macular degeneration). I am a 78 year old male with hereditary adult onset diabetes, and am on a number of medications. I tried using I-Caps about a year ago and had some nausea along with some physical discomfort when I began regularly using I-Caps. I stopped using it and the nausea and discomfort disappeared. The medications I use at this time are: Insulin, Benecar, Diltiaz, Lovastain, Enelapril, Warfarin and Digoxin. I do plan to discuss this with my primary care physician, but your website seems pretty comprehensive, and your California medical license looks good, so in the hope you are able to answer these questions for me, I'm writing. I need to know if there is a possibility of any side effect or related complication if I use one of your eye care products along with my current medications.
    It is very difficult to give specific suggestions or make predictions without examining a patient and not being familiar with the total medical history.